Excision of Epidermoid / Sebaceous Cyst
5th April 2011Rhinoplasty
Mr. Adrian Richards, plastic surgeon of Aurora clinics demonstrates a minor surgical procedure of removing a sebaceous or epidermoid cyst from a lady's anti-rear neck area under local anaesthetic.
Transcript
Sebaceous Cyst Removal
Hello. This is Adrian Richards. Today in this, one of our series of training videos on minor surgery, I’m going to be showing you how to remove an epidermoid cyst.
Epidermoid cysts are also known as sebaceous cysts. They occur very commonly on the torso. The one I’m going to be removing today is on the presternal area. I actually always quite enjoy removing epidermoid cysts, because it’s quite a challenge to try and get them out intact without rupture. You will see in this video that I don’t succeed in this and unfortunately rupture the cyst. This does happen on occasion.
It’s made more likely to rupture the cyst when the area’s been inflamed. This lady’s had a number of occasions of inflammation which required antibiotics to treat the cyst. Ideally, treat the cysts before they become infected, and then you’re more likely to get them out in one. If they have been infected, much more scarring, much more difficult to get out as I’ll show you.
Here you can see this lady’s got a sebaceous cyst on her anterior neck area. I’m cleaning it with aqueous chlorhexidine. I’ve already done some markings and put my local anaesthetic in.
Here I am just marking again. I’m using a fine nibbed pen, and I’m marking just where I’m going to make my ellipse. It’s very important to look out for a punctum, which is basically an open pore, and include that in your ellipse. That might be slightly off centre, but do include it because that’s the opening for the cyst.
I just cut through the skin initially there, and then gently with my pointed tenotomy scissors, we’ve got a fine end. We just try and dissect downwards by a mixture of spreading and cutting onto the wall of the cyst. Now on a fresh cyst, this has previously been infected, on a fresh cyst it’s much easier. You basically cut down till you see the white, glistening surface spreading onto the plane and then cutting any material above that. Then you should be able just to work gently around and get the cyst out. Now this cyst has been infected.
You can see there, unfortunately I’ve just burst it. But it’s important even if you do burst it, do try and get all the layer of the cyst out with the overlying skin ellipse.
Closure is just like many other closures we’ve done with the subcuticular stitches here. Often because it’s been inflamed, the area’s a bit scarred. So when you take the skin away, it does open up significantly. So I use these deep buried stitches of Monocryl, so I’ll use 50 Monocryl in this area. I’ll probably put two of them in. So one there, one now. That’s enough, if done correctly, to take all the tension off the incision and have no tension on the skin. As I’ve mentioned before, it’s the tension on the skin that causes poor scarring. These stitches really do help avoid that.
The final layer of closure is a subcuticular PDS. This is probably a 50, and I just run that along. This again has got no tension on it. That’s the important point, no tension on the skin. You can see there, that’s the thing and that’s where I’m going to cut the stitches after surgery.
Here’s the glue on, and finally here’s the Micropore tape, which we like to keep on for one week following surgery. Then that comes off and the ends of the stitches are trimmed.
I hope you enjoyed that, and I hope you understood the reasons for using this technique to remove the epidermoid cyst. I think overall the keys to it are try and get the epidermoid cysts before they’ve been infected because it’s easier to remove them intact. Put the local anaesthetic in as I described and sew the skin up as I described. Only remove a little bit of the skin, a small ellipse, ideally with the punctum in it. So look for that punctum and include it in your ellipse. It’s often not in the centre of the cyst. It can be slightly offset.
As I said, it’s quite challenging to remove them, even for experienced plastic surgeons to remove them intact, particularly if they’ve been infected and there’s a scarring, but it’s quite rewarding when you do. I think it’s something that’s certainly worth learning how to do properly.
If you’d like any more information about this or any other types of minor surgical procedures, please watch our videos. We’re aiming to provide a whole series of them covering all aspects of treatment. If you’ve got any other queries, please feel free to e-mail us. We’d be happy to advise you on any aspects of minor surgery. Thank you again for watching the video. I hope you enjoyed it.
Sebaceous Cyst Removal
Hello. This is Adrian Richards. Today in this, one of our series of training videos on minor surgery, I’m going to be showing you how to remove an epidermoid cyst.
Epidermoid cysts are also known as sebaceous cysts. They occur very commonly on the torso. The one I’m going to be removing today is on the presternal area. I actually always quite enjoy removing epidermoid cysts, because it’s quite a challenge to try and get them out intact without rupture. You will see in this video that I don’t succeed in this and unfortunately rupture the cyst. This does happen on occasion.
It’s made more likely to rupture the cyst when the area’s been inflamed. This lady’s had a number of occasions of inflammation which required antibiotics to treat the cyst. Ideally, treat the cysts before they become infected, and then you’re more likely to get them out in one. If they have been infected, much more scarring, much more difficult to get out as I’ll show you.
Here you can see this lady’s got a sebaceous cyst on her anterior neck area. I’m cleaning it with aqueous chlorhexidine. I’ve already done some markings and put my local anaesthetic in.
Here I am just marking again. I’m using a fine nibbed pen, and I’m marking just where I’m going to make my ellipse. It’s very important to look out for a punctum, which is basically an open pore, and include that in your ellipse. That might be slightly off centre, but do include it because that’s the opening for the cyst.
I just cut through the skin initially there, and then gently with my pointed tenotomy scissors, we’ve got a fine end. We just try and dissect downwards by a mixture of spreading and cutting onto the wall of the cyst. Now on a fresh cyst, this has previously been infected, on a fresh cyst it’s much easier. You basically cut down till you see the white, glistening surface spreading onto the plane and then cutting any material above that. Then you should be able just to work gently around and get the cyst out. Now this cyst has been infected.
You can see there, unfortunately I’ve just burst it. But it’s important even if you do burst it, do try and get all the layer of the cyst out with the overlying skin ellipse.
Closure is just like many other closures we’ve done with the subcuticular stitches here. Often because it’s been inflamed, the area’s a bit scarred. So when you take the skin away, it does open up significantly. So I use these deep buried stitches of Monocryl, so I’ll use 50 Monocryl in this area. I’ll probably put two of them in. So one there, one now. That’s enough, if done correctly, to take all the tension off the incision and have no tension on the skin. As I’ve mentioned before, it’s the tension on the skin that causes poor scarring. These stitches really do help avoid that.
The final layer of closure is a subcuticular PDS. This is probably a 50, and I just run that along. This again has got no tension on it. That’s the important point, no tension on the skin. You can see there, that’s the thing and that’s where I’m going to cut the stitches after surgery.
Here’s the glue on, and finally here’s the Micropore tape, which we like to keep on for one week following surgery. Then that comes off and the ends of the stitches are trimmed.
I hope you enjoyed that, and I hope you understood the reasons for using this technique to remove the epidermoid cyst. I think overall the keys to it are try and get the epidermoid cysts before they’ve been infected because it’s easier to remove them intact. Put the local anaesthetic in as I described and sew the skin up as I described. Only remove a little bit of the skin, a small ellipse, ideally with the punctum in it. So look for that punctum and include it in your ellipse. It’s often not in the centre of the cyst. It can be slightly offset.
As I said, it’s quite challenging to remove them, even for experienced plastic surgeons to remove them intact, particularly if they’ve been infected and there’s a scarring, but it’s quite rewarding when you do. I think it’s something that’s certainly worth learning how to do properly.
If you’d like any more information about this or any other types of minor surgical procedures, please watch our videos. We’re aiming to provide a whole series of them covering all aspects of treatment. If you’ve got any other queries, please feel free to e-mail us. We’d be happy to advise you on any aspects of minor surgery. Thank you again for watching the video. I hope you enjoyed it.