Excision of Sebaceous cyst/ Dermoid cyst

EXCISION OF SEBACEOUS CYST/ DERMOID CYST

  

 

Steps common to all minor procedures 

REQUIREMENTS: Written informed consent, local anaesthetic in a 2 or 5 ml syringe with needle, sterile gauze pieces, povidone-iodine, ethanol, sterile drape, scalpel with curved no. 15 blade, artery forceps, toothed forceps, needle holder, suture, dressing material

• Palpate the cyst and surrounding area to confirm its exact location and punctum
• Curved no. 15 blade is used to make an incision
• The longitudinal direction of the ellipse should be along Langer’s lines (vertical in limbs and horizontal on trunk)
• The width of ellipse = approx. 1/3 rd diameter of cyst and length considerably longer
• First incise the skin up to the subcutaneous tissues
• Then, using blunt and sharp dissection, identify the plane between the cyst and surrounding subcutaneous tissues
• Then, separate the superficial 25% of the circumference of the cyst with blunt dissection
• Now press the normal surrounding skin and soft tissues on both sides gently with the thumbs, first in
one direction, then at 90 degrees to the previous direction
• Around 80-90% of the cyst emerges from the incised area
• Gently lift up the incised ellipse of skin and attached cyst with forceps, and separate the deep pole of the cyst from underlying tissues using blade

  

 

GANGLION CYST EXCISION

It is similar to the above procedure, while bearing following in mind:
1. Careful dissection away from the tendons should be done
2. Feeding vessels to the ganglion need to be ligated
3. Special care should be taken not to injure major vessels like radial artery
4. The stalk of ganglion cyst should be traced and if arising from joint capsule, some part of joint capsule will have to be excised

PRACTICAL TIPS AND TRICKS:
1) While infiltrating, try to elevate the lesion by raising a wheal which allows the lesion to prop up
2) Keep a formalin filled pre-labelled container ready for putting the specimen in after its removal
3) Incisions should be made with the belly of blade

VIDEO LINK:
Excision of sebaceous cyst/ dermoid cyst: https://youtu.be/On9iKyDmtk8
Excision of ganglion cyst: https://youtu.be/KqOSb0TC8Ss

 

Written by our guest authors Anveshi Nayan and Shrishti Patil

Illustrations by Devi Bavishi
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