Incision, draining and exteriorization techniques Flashcards
Tumescent anaesthesia should not be used when removing larger cysts and lipomas.
F
The incision for removal of a lipoma should be one-half to one-third of the lesional diameter of the underlying lipoma.
T
Lipomas are not usually encapsulated
F They usually are
Lipomas will usually be lighter in colour and firmer than the surrounding adipose tissue.
T
Infiltrating lipomas frequently require an incision which is larger than for ordinary lipomas.
T
Lipomas frequently become inflamed
F
For lipoma removal local anaesthetic is injected over and around and under the lesion
T
When removing forehead lipomas, the frontalis muscle bundles should be dissected in a horizontal orientation.
F Vertical if possible.
After removal of an epidermal cyst, the wound should be irrigated with saline.
T
There is no indication to start antibiotics when excising epidermal cysts.
F Start if cyst inflamed.
Multiple epidermal cysts may be associated with Gardner syndrome and basal cell nevus syndrome
T
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.
T
When infiltrating local anaesthetic during epidermal cyst removal, avoid direct injection into the cyst cavity to prevent distention and possible rupture.
T
Treated milia tend to recur.
F
Pilar cysts more commonly require removal of redundant overlying skin.
T
Carbon dioxide laser can be used to exteriorize and destroy steatocystomas.
T
Local anaesthesia is often less effective in infective tissues because of the low pH of infected tissues.
T
Incision and drainage of inflammatory lesions is considered the preferred surgical treatment method for hidradenitis suppurativa.
F Exteriorisation of cysts and sinus tracks.
Unroofed areas left after surgical management of HS should be grafted.
F Leave to heal by second intention if possible.
Infiltrating lipomas and forehead lipomas are much deeper than they appear and are often under or between muscle.
T
Cysts which have been drained previously or which have been traumatised will often have significant scar tissue associated with them.
T
Infiltrating local anaesthetic in and around a cyst helps to dissect it free from the surrounding tissue.
T
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.
T
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
T
Packing of wounds can be performed with iodoform or plain gauze
T
Scrotal cyst excision sites generally heal faster.
F Slower – leave sutures in longer.
If drains are used after the removal of a subcutaneous lesion, these are typically removed in 24 hours.
F 72-96hrs.
CT or MRIs should be performed pre-operatively for infiltrating lipomas to determine the extent of involvement.
T
In removing milia, steatocystomas and apocrine hidrocystomas, minimal surgery should be done to avoid possible excess scar formation.
T
Scrotal cysts may be calcified and more fibrotic, lending themselves to fusiform excisions.
T
Medical treatment of hidradenitis suppurativa is topical antibiotics only
F Topical and oral Abx
In hidradenitis suppurativa exteriorization of cysts and sinus tracts is considered the preferred method of treatment
T
After surgical treatment of hidradenitis suppurativa the wound is closed with primary closure
F Secondary intent, large defects are left to granulate
For cysts and lipomas make an initial incision equal to the diameter of the lesion
F Radius
Under no circumstances should a cyst be decompressed
F
Lipomas on the forehead are often underneath the frontalis muscle
T
Lipomas are non-encapsulated subcutaneous lesions
F encapsulated
Most lipomas are asymptomatic
T
Lipomas rarely become inflamed
T
Lipomas on the upper extremities may be deep and involve the muscles and neural and vascular structures
T
The incision length of a lipoma should be ½-1/3 of the lesion diameter
T
Inject the LA in the lipoma
F
Inject the LA over, around and under the lipoma or cyst
T
Injecting the LA around the lesion may help it get dissected
T
Blunt dissection of a lipoma via a haemostat, Ragnel or Metzenbaum
T
Apply vertical compression to enable lipoma to squeeze it through the incision line
F
lateral
If drains are used should be removed in 72-96 hours
T
The supratrochlear and supraorbital nerve bundles may be injured if care is not taken during removal of a lipoma of the forehead
T
In order to access a frontalis associated lipoma, the frontalis muscle is dissected horizontally to separate the muscle fibres
F
vertically
A pressure dressing is helpful post removal of a frontalis associated lipoma
T
Intermuscular lipomas are poorly demarcated
F
intramuscular are
Intramuscular lipomas are firmer than normal lipomas
T
If a lipoma is located near Erb’s point, a nerve stimulator should be used
T
The initial incision for removal of a cyst or lipomas is half the radius of the lesion
False
equal to the radius
Multiple epidermoid cysts is associated with Cowden’s syndrome and Gorlins
F
Gardners and Gorlins
When excising an epidermoid cyst, make the incision line through the epidermal pore
T
The incision line can be made into a fusiform excision if there is significant fibrosis or scar
T
Oral abs that cover pseudomonas should be given when excising cysts that are mildly inflamed
F – staph and strep
Trichilemmal cysts are more commonly seen in men than women
F
Trichelemmal cysts often have a punctum
F
Pilar cysts have a thick wall
T
The inelastic nature of the scalp makes undermining and closing the dead space more difficult
T
There may be a fibrous capsule at the lateral margin surrounding the lesion
T
The thick wall allows the pilar cyst to be easily delivery through the incision
T
The pilar cyst is the true sebaceous cyst
F
steatocystoma is
The most common site of a steatocystoma is the scalp
F
sternum
Steatocystomas often have an overlying pore
F
Steatocystomas may be associated with surrounding open comedones
T
Apocrine hidrocystomas are usually in the periocular area
T
The blue discolouration of an apocrine hidrocystomas is due to the tyndall phenomenon, extravasated rbcs, and lipofuscin
T
BCCs are softer and smoother than hidrocystomas
F
Topical antibiotics are not recommended for removal of periocular lesions
F
Infected tissues have a higher pH and therefore LA is less effective
F
lower pH
Infected cysts may require packing or a wound drain
T
Packing can be performed with iodoform or plain gauze
T
Broad spectrum Abs should be given after I&D
T
Medical treatment of hidradenitis suppurative includes topical and oral abs
T
The primary cause of problems in HS is the inflammation of apocrine, eccrine and sebaceous glands
F secondary
The exteriorization of cysts and sinus tracts should be allowed to heal by primary intention
F
secondary
Large lesions should be allowed to granulate
T
When I&D milia, the cyst wall will often be extruded with the keratinous contents
T
Epidermoid cysts are easier to remove than steatocystomas
F
Scrotal cysts/lesions may require fusiform excision
T
Scrotal lesions heal quickly
F
slow
Injury to the brachial plexus may result in shoulder droop and the hand rotated laterally
F
medial rotation
