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Using Smooth Forceps for Assisting Incision and Drainage of an Infected Epidermoid Cyst
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersIncision and drainage is the initial treatment choice for an infected epidermoid cyst. During the procedure, collected keratin may accumulate at the incision site, making drainage challenging (Fig 1). If the cyst is compressed too hard, these potentially infectious and odorous materials may suddenly spray out. Comprehensive protective equipment such as gown, facial shield, and goggles may not always be used due to inconvenience, personal preference, or unavailability. Moreover, multiple forcible squeezes can cause further tissue inflammation, leading to excessive erythema, swelling, and pain.
Additional Info
Using Smooth Forceps for Assisting Incision and Drainage of an Infected Epidermoid Cyst
J Am Acad Dermatol 2018 Feb 03;[EPub Ahead of Print], YS Chang, TH Lee, HH Tsai, HH WangFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
I enjoyed reading this article that highlights the use of a 2- to 3-mm incision followed by use of a smooth forceps to stretch the opening of infected keratinous cysts and prevent splattering of cyst contents when the lesion is “squeezed.” Years ago, my team highlighted the use of a 4- or 6-mm punch to incise cysts whether infected or not.1 The use of a forceps can certainly help extrude the contents of the cyst whether the incision is made with a #11 blade or punch. We agree with these authors that it makes no difference if the cyst is broken and the wall removed in pieces. Critically important is the removal of the entire cyst wall to prevent recurrence of the cyst. Our study showed about an 8% recurrence rate. When cysts recur, we use the same punch technique to remove the recurrent lesion.
I universally do a punch excision of epidermoid cysts in my practice. Whereas a punch tool creates a larger opening than a minimal straight-line incision for cyst extraction, the small “dog-ears” created by closing a punch incision are eliminated by the normal elasticity of the skin during the healing process. The larger opening and the use of forceps eliminates the splatter mentioned in this article.
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