Aesthetic outcome of biquadrangular and Hueston dorsal flaps in digital mucous cyst surgery

Digital mucous cysts (DMCs) are common benign lesions of the distal interphalangeal joint that may cause pain, nail deformity or aesthetic dissatisfaction. Surgical treatment consists of cyst excision with local flap coverage to achieve satisfactory soft-tissue reconstruction. However, limited data are available comparing the aesthetic outcomes between flap techniques.

We conducted a retrospective study of patients who underwent surgical treatment for a DMC at our University Hospital between January 2019 and July 2024, with a minimum follow-up of 1 year. Two local flap techniques were used for skin coverage: the biquadrangular flap and the Hueston flap. Aesthetic outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes included nail dystrophy, cyst recurrence, joint stiffness and postoperative infection.

Fifty patients were included: 27 treated with a biquadrangular flap and 23 with a Hueston flap. No statistically significant differences were observed between the two groups in patient or observer POSAS scores. Likewise, there were no significant differences regarding secondary outcomes, including nail dystrophy, recurrence, joint stiffness or infection.

Both biquadrangular and Hueston flaps yield comparable aesthetic satisfaction and clinical outcomes after surgical excision of digital mucous cysts. Flap selection does not appear to influence scar quality or postoperative complications and may therefore be guided by surgeon preference, anatomical considerations and patient expectations.