Mucous Cyst Excision

These are examples of a technique for mucous cyst excision using a longitudinal eponychial splitting incision I learned from Damien Ireland. Mucous cysts arise from the dorsal DIP joint capsule, often associated with small dorsal osteophytes of the distal phalanx. The cyst itself is a secondary effect and needs no treatment. Joint debridement addresses the source of the problem.
  • Leave the cyst itself undisturbed
  • Use a longitudinal incision and elevate a flap superficial to the extensor mechanism
  • Excise the dorsal hemicircumference of the joint capsule.
  • Use a 2mm Kerrison punch to debride osteophytes proximal to the terminal tendon insertion
  • Close the deep eponychial surface with a pullout suture and then close with a simple running suture.

Case 1. Nail deformity

Case 1: Late Result

Case 2. Incision through cyst

Case 2: Late Result

Case 3. Eponychial cyst, nail deformity

Case 3: Early Result

Case 3: Late Result

Case 4. Nail thinning

Case 4: Late Result

Case 5. Use a linear incision for the most reliable healing

Use a pullout stitch to close the deep eponychial surface and take tension off of the closure.

Case 5: Closure

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