Case Series Selection of Surgical Approaches for Myxoid Pseudocyst According to Anatomical Location: A Four-Case...

The myxoid pseudocyst is the most common tumor-like lesion of the hand. It develops when synovial fluid leaks from the distal interphalangeal (DIP) joint, usually in the context of osteoarthritis, and typically appears between the proximal nail fold and the DIP joint in middle-aged women. Surgery has the lowest recurrence rates, yet the operative techniques themselves are rarely described in detail.

We present a four-patient case series illustrating the selection of established surgical approaches according to the lesion location. The type B lesion was removed through a V-shaped incision and closed with a V-T flap. The subungual type C lesion required partial avulsion of the nail plate for resection of the myxoid pseudocyst and repositioning of the avulsed plate. The two type A lesions were approached differently depending on their position: one close to the proximal nail fold was excised through an L-shaped incision in the fold, while one lying just above the DIP joint crease was reached with a simple linear incision. The nail plate was preserved in both.

Knowledge of the De Berker anatomical classification is useful for planning resection and for the preservation of the nail apparatus.