Incision, draining and exteriorization techniques

Question 1

Tumescent anaesthesia should not be used when removing larger cysts and lipomas.

Answer 1

F

Question 2

The incision for removal of a lipoma should be one-half to one-third of the lesional diameter of the underlying lipoma.

Answer 2

T

Question 3

Lipomas are not usually encapsulated

Answer 3

F They usually are

Question 4

Lipomas will usually be lighter in colour and firmer than the surrounding adipose tissue.

Answer 4

T

Question 5

Infiltrating lipomas frequently require an incision which is larger than for ordinary lipomas.

Answer 5

T

Question 6

Lipomas frequently become inflamed

Answer 6

F

Question 7

For lipoma removal local anaesthetic is injected over and around and under the lesion

Answer 7

T

Question 8

When removing forehead lipomas, the frontalis muscle bundles should be dissected in a horizontal orientation.

Answer 8

F Vertical if possible.

Question 9

After removal of an epidermal cyst, the wound should be irrigated with saline.

Answer 9

T

Question 10

There is no indication to start antibiotics when excising epidermal cysts.

Answer 10

F Start if cyst inflamed.

Question 11

Multiple epidermal cysts may be associated with Gardner syndrome and basal cell nevus syndrome

Answer 11

T

Question 12

If considerable fibrosis is encountered during removal of a cyst, the best course is to perform a fusiform excision including the fibrotic area and underlying cyst.

Answer 12

T

Question 13

When infiltrating local anaesthetic during epidermal cyst removal, avoid direct injection into the cyst cavity to prevent distention and possible rupture.

Answer 13

T

Question 14

Treated milia tend to recur.

Answer 14

F

Question 15

Pilar cysts more commonly require removal of redundant overlying skin.

Answer 15

T

Question 16

Carbon dioxide laser can be used to exteriorize and destroy steatocystomas.

Answer 16

T

Question 17

Local anaesthesia is often less effective in infective tissues because of the low pH of infected tissues.

Answer 17

T

Question 18

Incision and drainage of inflammatory lesions is considered the preferred surgical treatment method for hidradenitis suppurativa.

Answer 18

F Exteriorisation of cysts and sinus tracks.

Question 19

Unroofed areas left after surgical management of HS should be grafted.

Answer 19

F Leave to heal by second intention if possible.

Question 20

Infiltrating lipomas and forehead lipomas are much deeper than they appear and are often under or between muscle.

Answer 20

T

Question 21

Cysts which have been drained previously or which have been traumatised will often have significant scar tissue associated with them.

Answer 21

T

Question 22

Infiltrating local anaesthetic in and around a cyst helps to dissect it free from the surrounding tissue.

Answer 22

T

Question 23

After incision and drainage of an abscess, a wick of material can be left extruded from the gauze packing – this should be advanced approximately 1 cm per day with each dressing change until it is removed.

Answer 23

T

Question 24

Once a cavity of an infected cyst has been irrigated with saline a decision is made whether packing the wound or insertion of a drain is necessary

Answer 24

T

Question 25

Packing of wounds can be performed with iodoform or plain gauze

Answer 25

T

Question 26

Scrotal cyst excision sites generally heal faster.

Answer 26

F Slower – leave sutures in longer.

Question 27

If drains are used after the removal of a subcutaneous lesion, these are typically removed in 24 hours.

Answer 27

F 72-96hrs.

Question 28

CT or MRIs should be performed pre-operatively for infiltrating lipomas to determine the extent of involvement.

Answer 28

T

Question 29

In removing milia, steatocystomas and apocrine hidrocystomas, minimal surgery should be done to avoid possible excess scar formation.

Answer 29

T

Question 30

Scrotal cysts may be calcified and more fibrotic, lending themselves to fusiform excisions.

Answer 30

T

Question 31

Medical treatment of hidradenitis suppurativa is topical antibiotics only

Answer 31

F Topical and oral Abx

Question 32

In hidradenitis suppurativa exteriorization of cysts and sinus tracts is considered the preferred method of treatment

Answer 32

T

Question 33

After surgical treatment of hidradenitis suppurativa the wound is closed with primary closure

Answer 33

F Secondary intent, large defects are left to granulate

Question 34

For cysts and lipomas make an initial incision equal to the diameter of the lesion

Answer 34

F Radius

Question 35

Under no circumstances should a cyst be decompressed

Answer 35

F

Question 36

Lipomas on the forehead are often underneath the frontalis muscle

Answer 36

T

Question 37

Lipomas are non-encapsulated subcutaneous lesions

Answer 37

F encapsulated

Question 38

Most lipomas are asymptomatic

Answer 38

T

Question 39

Lipomas rarely become inflamed

Answer 39

T

Question 40

Lipomas on the upper extremities may be deep and involve the muscles and neural and vascular structures

Answer 40

T

Question 41

The incision length of a lipoma should be ½-1/3 of the lesion diameter

Answer 41

T

Question 42

Inject the LA in the lipoma

Answer 42

F

Question 43

Inject the LA over, around and under the lipoma or cyst

Answer 43

T

Question 44

Injecting the LA around the lesion may help it get dissected

Answer 44

T

Question 45

Blunt dissection of a lipoma via a haemostat, Ragnel or Metzenbaum

Answer 45

T

Question 46

Apply vertical compression to enable lipoma to squeeze it through the incision line

Answer 46

F | lateral

Question 47

If drains are used should be removed in 72-96 hours

Answer 47

T

Question 48

The supratrochlear and supraorbital nerve bundles may be injured if care is not taken during removal of a lipoma of the forehead

Answer 48

T

Question 49

In order to access a frontalis associated lipoma, the frontalis muscle is dissected horizontally to separate the muscle fibres

Answer 49

F | vertically

Question 50

A pressure dressing is helpful post removal of a frontalis associated lipoma

Answer 50

T

Question 51

Intermuscular lipomas are poorly demarcated

Answer 51

F | intramuscular are

Question 52

Intramuscular lipomas are firmer than normal lipomas

Answer 52

T

Question 53

If a lipoma is located near Erb’s point, a nerve stimulator should be used

Answer 53

T

Question 54

The initial incision for removal of a cyst or lipomas is half the radius of the lesion

Answer 54

False | equal to the radius

Question 55

Multiple epidermoid cysts is associated with Cowden’s syndrome and Gorlins

Answer 55

F | Gardners and Gorlins

Question 56

When excising an epidermoid cyst, make the incision line through the epidermal pore

Answer 56

T

Question 57

The incision line can be made into a fusiform excision if there is significant fibrosis or scar

Answer 57

T

Question 58

Oral abs that cover pseudomonas should be given when excising cysts that are mildly inflamed

Answer 58

F – staph and strep

Question 59

Trichilemmal cysts are more commonly seen in men than women

Answer 59

F

Question 60

Trichelemmal cysts often have a punctum

Answer 60

F

Question 61

Pilar cysts have a thick wall

Answer 61

T

Question 62

The inelastic nature of the scalp makes undermining and closing the dead space more difficult

Answer 62

T

Question 63

There may be a fibrous capsule at the lateral margin surrounding the lesion

Answer 63

T

Question 64

The thick wall allows the pilar cyst to be easily delivery through the incision

Answer 64

T

Question 65

The pilar cyst is the true sebaceous cyst

Answer 65

F | steatocystoma is

Question 66

The most common site of a steatocystoma is the scalp

Answer 66

F | sternum

Question 67

Steatocystomas often have an overlying pore

Answer 67

F

Question 68

Steatocystomas may be associated with surrounding open comedones

Answer 68

T

Question 69

Apocrine hidrocystomas are usually in the periocular area

Answer 69

T

Question 70

The blue discolouration of an apocrine hidrocystomas is due to the tyndall phenomenon, extravasated rbcs, and lipofuscin

Answer 70

T

Question 71

BCCs are softer and smoother than hidrocystomas

Answer 71

F

Question 72

Topical antibiotics are not recommended for removal of periocular lesions

Answer 72

F

Question 73

Infected tissues have a higher pH and therefore LA is less effective

Answer 73

F | lower pH

Question 74

Infected cysts may require packing or a wound drain

Answer 74

T

Question 75

Packing can be performed with iodoform or plain gauze

Answer 75

T

Question 76

Broad spectrum Abs should be given after I&D

Answer 76

T

Question 77

Medical treatment of hidradenitis suppurative includes topical and oral abs

Answer 77

T

Question 78

The primary cause of problems in HS is the inflammation of apocrine, eccrine and sebaceous glands

Answer 78

F secondary

Question 79

The exteriorization of cysts and sinus tracts should be allowed to heal by primary intention

Answer 79

F | secondary

Question 80

Large lesions should be allowed to granulate

Answer 80

T

Question 81

When I&D milia, the cyst wall will often be extruded with the keratinous contents

Answer 81

T

Question 82

Epidermoid cysts are easier to remove than steatocystomas

Answer 82

F

Question 83

Scrotal cysts/lesions may require fusiform excision

Answer 83

T

Question 84

Scrotal lesions heal quickly

Answer 84

F | slow

Question 85

Injury to the brachial plexus may result in shoulder droop and the hand rotated laterally

Answer 85

F | medial rotation