Arch Hand Microsurg.  2024 Jun;29(2):90-95. 10.12790/ahm.24.0014.

The Zitelli bilobed flap for soft tissue coverage after mucoid cyst resection: a retrospective cohort study

• Oh S
• Chung J
• Son D

• KMID: 2556358
• DOI: http://doi.org/10.12790/ahm.24.0014

Abstract

Purpose
Digital mucoid cysts are frequently found at the distal interphalangeal (DIP) joint in patients with degenerative osteoarthritis. In complicated cases, surgical treatment with mucoid cyst resection is considered, and soft tissue is covered with one of various local flap techniques. Among these, bilobed flaps are reliable and aesthetically favorable, with primary healing of the donor site. In this study, we investigated a case series of bilobed flaps for digital mucoid cysts.
Methods
We retrospectively reviewed our electronic medical records and found 26 digital mucoid cysts treated with bilobed flaps at our facility between July 2022 and February 2024. We extracted data from the records of these patients on sex; age; time to surgery; clinical findings including nail ridging, the presence of osteophytes, cyst size and location, and additional procedures (arthrodesis); and follow-up data including the occurrence of complications, such as delayed wound healing, infection, stiffness, and recurrence.
Results
Among the 26 patients in our sample, 19 were female and seven were male. The average age was 62.2 years, and the average time to surgery was 10.8 months. Preoperatively, the average cyst measured 6.9×8.3 mm. Nail ridging was found in 19 patients (73.1%) and osteophytes in 22 patients (84.6%). The most commonly affected digit was the middle finger, which accounted for 10 cases (38.5%). All the flaps totally survived, without major complications.
Conclusion
Based on our series, a bilobed flap for soft tissue coverage after mucoid cyst excision can achieve high-quality surgical results.

Keyword

Flap; Ganglion cysts; Osteoarthritis; Myxoid cyst

Figure

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  Fig. 1. (A) The design of a geometric bilobed flap for soft tissue defects. Axis A passes through the center of the defect, and axis B passes through the center of the second lobe. The A–B angle is usually 80° to 90° in digital bilobed flaps. (B) A bilobed flap in a 67-year-old woman after digital mucoid cyst resection. The image shows the preoperative flap design (left), an immediate postoperative photograph (center), and clinical photographs taken 6 months postoperatively (right). (C) A bilobed flap in a 55-year-old woman after digital mucoid cyst resection. The image shows the preoperative flap design, intraoperative, immediate postoperative photographs, and 6-month postoperative clinical photographs.

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  Fig. 2. (A) In this patient, a preoperative X-ray examination showed a prominent distal phalangeal osteophyte. (B) After osteophyte resection, flattening of the distal phalanx was observed.

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  Fig. 3. A bilobed flap with distal interphalangeal (DIP) joint arthrodesis in a 71-year-old woman after digital mucoid cyst resection. (A) Preoperative and immediate postoperative clinical photographs. (B) Severe DIP joint degenerative osteoarthritis was seen, and DIP joint arthrodesis with intramedullary screw fixation was performed. A bilobed flap with DIP joint arthrodesis in a 78-year-old woman after digital mucoid cyst resection. (C) Preoperative, immediate postoperative, and 6-month postoperative follow-up clinical photos. (D) Severe DIP joint degenerative osteoarthritis was seen, and DIP joint arthrodesis with intramedullary screw fixation.

Reference

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