Objective <p>Excision of the cyst and, if necessary, reconstructive coverage.</p> Indications <p>Thinned skin over the distal joint or at the proximal nail fold with the risk of perforation. Perforated mucoid cysts with discharge of mucoid material, with the risk of infection up to joint infection. Occasionally, the mucoid cyst content drains from the proximal nail fold, and even more rarely, it emerges under the nail. Nail growth disorders caused by a&#xa0;cyst sac overlying the proximal nail plate.</p> Contraindications <p>An existing infection requires at least simultaneous treatment of the infection, and possibly also of the joint infection. In cases of significantly painful distal joint osteoarthritis, simultaneous distal joint fusion should be considered.</p> Surgical technique <p>Supine position with the pronated arm placed on the arm table. Digital nerve block anesthesia. Bloodless surgical field. Triangular excision of the thinned skin. If necessary, distal undermining of the skin and distal enucleation of the ganglion sac. Longitudinal incision towards the proximal end and dissecting the soft tissue envelope along the extensor aponeurosis. The skin should only be held back with a&#xa0;skin hook and not pinched with forceps. Excision of the joint capsule including the ganglion stalk and removal of osteophytes as needed. Flipping of the stretching flap and close-meshed skin suturing. Application of a&#xa0;stabilizing dressing and removal of the finger tab.</p> Postoperative management <p>Keep the arm raised consistently. The stabilizing bandage should support wound healing for one week. Removal of stitches after 14&#xa0;days.</p>