para>Courtesy of Dr. Scott Bergeaux.View Original Step 2
Courtesy of Dr. Scott Bergeaux.
View Original
Ablation of the Cyst Base
Step 1
After the application of local or digital block anesthesia (see Local Anesthesia Administration and Digital Nerve Block Anesthesia), shave off the skin and cyst roof using a horizontally held no. 15 scalpel blade. Apply the cryosurgery probe to the cyst base, and create an ice ball that extends outward onto 2 to 3 mm of the normal-appearing surrounding skin. Alternatively, spray the base with a liquid nitrogen sprayer to the same diameter. Use the freeze " thaw " freeze technique.
- PITFALL: Avoid prolonged freezing of the tissues, because notching of the proximal nail fold may develop. The length of the freeze is based on the observed size of the ice ball.
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Excision
Step 2
After digital anesthesia, the skin over the cyst is excised, and the cyst is dissected and excised from the surrounding tissues.
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Step 3
Incise a V-shaped base to this circular defect, creating a defect shaped like an ice cream cone.
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Step 4
A small, inverted U-shaped rotation flap is incised and undermined from nearby skin on the dorsum of the finger.
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Step 5
The flap may be moved over the defect and preferably left to heal to the wound bed. Note that suturing the flap may be preferable, because the larger wound produces scarring that may help to reduce cyst recurrence.
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Step 6
Often, the flap does not center over the wound, or excessive bleeding may occur. A single stitch on one or both sides of the flap can help alleviate these problems. Antibiotic ointment and splinting are provided after the procedure.
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Complications
- Notching of the proximal nail fold
- Cyst recurrence
- Scarring of the nail matrix with nail dystrophy
- Local depigmentation after steroid injection
- Radial or ulnar deviation of the DIP joint
- Tendon injury
- DIP septic arthritis
- Persistent swelling
- Pain or numbness
Pediatric Considerations
Digital mucous cysts are rare in childhood.
Postprocedure Instructions
Antibiotic ointment and a light gauze dressing are placed after cyst treatments. Gentle active range of motion is allowed, and sutures usually are removed after 2 weeks.
Coding Information and Supply Sources
View Large CPT Code Description 2008 Average 50th Percentile Fee Global Period 20612 Aspiration or injection of ganglion cyst, any site $135.00 0 26160 Excision of lesion of tendon sheath or joint capsule (mucous cyst) $1,050.00 90 CPT is a registered trademark of the American Medical Association.2008 average 50th Percentile Fees are provided courtesy of 2008 MMH-SI 's copyrighted Physicians ' Fees and Coding Guide.
Instrument and Materials Ordering
- A standard office surgery tray, as described in Appendix G, should be available for the excision procedure.
- A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
- Skin preparation recommendations appear in Appendix E.
Bibliography
1
Bennett RG.
Fundamentals of Cutaneous Surgery
. St. Louis: CV Mosby; 1988:754 " 756. 2
Dodge LD, Brown RL, Niebauer JJ, et al. The treatment of mucous cysts: long-term follow-up in sixty-two cases.
J Hand Surg Am.
1984;9:901 " 904. [View Abstract]
3
Epstein E. A simple technique for managing digital mucous cysts.
Arch Dermatol.
1979;115:1315 " 1316. [View Abstract]
4
Fritz GR, Stern PJ, Dickey M. Complications following mucous cyst excision.
J Hand Surg Br.
1997;22:225 " 225. 5
Haneke E, Baran R. Nails: surgical aspects. In: Parish LC, Lask GP, eds.
Aesthetic Dermatology
. New York: McGraw-Hill; 1991:236 " 241. 6
Hernandez-Lugo AM, Dominguez-Cherit J, Vega-Memije AE. Digital mucoid cyst: the ganglion type.
Intl Dermatol
. 1999;38:531 " 538. 7
Salasche SJ. Myxoid cysts of the proximal nail fold: a surgical approach.
J Dermatol Surg Oncol
. 1984;1035 " 1039. 8
Singh D, Osterman AL. Mucous cyst. E-medicine. Available at http://www.emedicine.com/orthoped/topic520.htm. Accessed February
21, 2002. 9
Sonnex TS. Digital myxoid cysts: a review.
Cutis
. 1986;37:89 " 94. [View Abstract]
10
Zuber TJ. Office management of digital mucous cysts.
Am Fam Physician.
2001;64:1987 " 1990. [View Abstract]
11
2008 MAG Mutual Healthcare Solutions, Inc. 's
Physicians ' Fee and Coding Guide. Duluth, Georgia. MAG Mutual Healthcare Solutions, Inc.
2007.