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Sebaceous cyst excision

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Published on Aug 4, 2011

Complete Excision of A sebaceous cyst on the scalp by Halim Grace.
1. Local anesthesia infiltration surrounding the cyst and beneath the cyst but not in the cyst . Lidocaine 2% with adrenaline is preferred as the scalp is very vascular . Sedation was by a tiny dose Of fentanyl.
2. A linear incision near the punctum was done with a number 15 scalpel. Although an elliptical incision enclosing the punctum is the most popular method.
3. The skin edges were raised by allis forceps ( skin hooks are less traumatic , but they weren't available)
4. Sharp dissection was done by the scalpel , in a circumferential manner , to achieve an adequate plane for blunt dissection .
5. Blunt dissection was done using curved scissors. Keeping the convex side up , and dissecting the cyst from the skin and surrounding tissue.
6. Small bleeders are cauterized by diathermy .
7. Suturing was done with silk 2-0. Dead space is minimized by taking a deeper bite . Edges of the skin should be everted .
8. Patient is instructed not to get water on the wound , and a follow up visit to replace the dressing was done On the 4th day following the surgery .
Sutures are removed after 6 days , as the scalp is very vascular and heals very fast.
N.B . If the cyst was inflamed , then I wouldn't have suggested excision until the inflammation subsides. Also if the cyst has been inflamed previously then excision without rupturing the cyst wall is not easy due to adhesions to the surrounding tissues.
If an abcess forms then treatment is only incision and drainage , and if possible excising as much as the sac as possible , (anatomy would be distorted) This has an increase in recurrence rate .
I dont advocate the minimal Excision technique ; were a tiny incision is done , and the contents of the cyst are squeezed out , then the sac removed . Simply because how will you know that you've excised the whole wall of the cyst. Surgeons that like this technique say that the incision is smaller , and operative time is not as much and stitches aren't required .

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