The Internet Journal of Plastic Surgery ISPUB.COM Volume 7 Number 1 Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide S Shah, R Wain, S Syed Citation S Shah, R Wain, S Syed. Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide. The Internet Journal of Plastic Surgery. 2009 Volume 7 Number 1. Abstract Excision of a sebaceous cyst is a common procedure carried out in plastic and general surgical departments and in general practice. The cyst should be excised completely in order to avoid recurrence. If the cyst ruptures during the procedure there is an increased infection risk and recurrence rates are higher. Several methods have been employed for excising sebaceous cysts but none guarantee complete excision without rupture 1, 2, 3, 4, and some techniques advocate it 5. We describe in detail a technique which dramatically reduces the occurrence of cyst rupture. INTRODUCTION 8. Once this plane is identified separate the We demonstrate a step-by-step pictorial guide of the method superficial 25% of the circumference of the cyst we follow to excise sebaceous cysts. This technique with blunt dissection. minimizes the probability of cyst rupture due to minimal 9. Now press the normal surrounding skin and soft direct handling of the cyst itself. This method, if carried out tissues on both sides gently with the thumbs, first correctly, is effective in ensuring that all cyst contents and in one direction, then at 90 degrees to the previous the cyst wall are removed. direction. (Images 6 & 7) METHOD 10. Around 80-90% of the cyst emerges from the STEP-BY-STEP GUIDE incised area. 1. Palpate the cyst and surrounding area to confirm its 11. Gently lift up the incised ellipse of skin and exact location and punctum. (Image 1) attached cyst with forceps, and separate the deep 2. Draw an ellipse around the punctum over the cyst pole of the cyst from underlying tissues using with a skin marker. The longitudinal direction of scissors. (Image 8) the ellipse should be in the direction of the natural 12. Ensure haemostasis and close the skin with non skin creases. (Image 2) absorbable interrupted sutures. e.g. 6/0 Ethilon. 3. Infiltrate local anaesthesia using 2% Lignocaine (Image 9) with adrenaline. 13. Clean the wound with saline solution and dry. 4. Clean with anti septic solution. e.g. Betadine / 14. Apply steristrips and skin coloured tape. Chlorhexadine. 5. Cover the skin around the site of the cyst with IMAGES sterile drapes. (Image 3) 6. First incise the skin up to the subcutaneous tissues using a scalpel (Image 4). 7. Then, using blunt and sharp dissection, identify the plane between the cyst and surrounding subcutaneous tissues. (Image 5) 1 of 5 Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide Figure 1 Figure 4 Image 1 Image 4 Figure 2 Image 2 Figure 5 Image 5 Figure 3 Image 3 2 of 5 Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide Figure 6 Figure 8 Image 6 Image 8 Figure 7 Figure 9 Image 7 Image 9 DISCUSSION Sebaceous cysts are benign, firm to fluctuant lesions that often occur behind the ears, on the face, neck, scalp, trunk and scrotum. They have a dark keratin plug overlying the cyst cavity and are usually mobile on palpation. They can range from a few millimetres to a few centimetres in diameter and their contents are a thick, foul smelling combination of keratin and lipids 6, 7. The most common cause of a sebaceous cyst is rupture of a pilosebaceous follicle associated with acne. Other causes include a developmental defect of the sebaceous duct or traumatic implantation of surface epithelium beneath the skin 6, 7. We are not aware of another step-by-step pictorial guide for 3 of 5 Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide this novel technique. The method described is effective in through mini-incisions. Br J Plast Surg 1975;28:307-9. 4. Humeniuk HM, Lask GP. Treatment of benign cutaneous removing the cyst while ensuring it stays intact however, if lesions. In: Parish LC, Lask GP, eds. Aesthetic dermatology. handled roughly the cyst wall may still rupture. New York: McGraw-Hill, 1991:39-49 5. Zuber TJ. Am Fam Physician. 2002 Apr 1;65(7):1409-12, References 1417-8, 1420 6. Cruz AB, Aust JB. Lesions of the skin and subcutaneous 1. Suliman MT. Excision of epidermoid (sebaceous) cyst: tissue. In: Hardy JD, Kukora JS, Pass HI, eds. Hardy's description of the operative technique. Plast Reconstr Surg Textbook of surgery. Philadelphia: Lippincott, 1983:319-28. 2005;116:2042-3. 7. Domonkos AN, Arnold HL, Odom RB. Andrews' 2. Nakamura M. Treating a sebaceous cyst: an incisional Diseases of the skin: clinical dermatology. 7th ed. technique. Aesthetic Plast Surg 2001;25:52-6. Philadelphia: Saunders, 1982. 3. Moore C, Greer DM, Jr. Sebaceous cyst extraction 4 of 5 Step-by-Step Sebaceous Cyst Excision: A Pictorial Guide Author Information S H A Shah, MBBS, FRCSI Registrar in Plastic & Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Royal Preston Hospital R A J Wain, MBChB CT1 in Plastic & Reconstructive Surgery, Department of Plastic and Reconstructive Surgery, Royal Preston Hospital S Syed, MBBS Department of General Surgery, St Luke`s General Hospital 5 of 5.