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
