East Anglian Department of Plastic Surgery, Norwich, England

Transcription

1 British Journal of Plastic Surgery (1972), 25, TREPHINING SEBACEOUS CYSTS By PAUL J. O'KEEFFE, F.R.C.S. East Anglian Department of Plastic Surgery, Norwich, England WHEN a disc of skin including the punctum of a sebaceous cyst and a disc of the underlying cyst wall is excised, the lining anastomoses to the skin edge and a wide " duct" is created. Full drainage of the cyst can now occur and the cyst cavity shrinks until after about 6 weeks all that remains is a small pit (Figs. I and 2). Cysts of the cheek drain best of all, probably due to the massaging effect of the underlying muscles ; cysts at other sites, especially flabby ones on the scalp, need to be expressed daily if drainage is to be complete. Such marsupialisation of sebaceous cysts is not new. Danna (1945, 1946) described a technique using a diathermy needle to cauterise a portion of the overlying skin and the cyst wall. Patton (1963) mentions the use of a trephine but recommends it only for the very rare case as in his opinion the result is a small fibrous cyst requiring subsequent excision., In a trial at the East Anglian Department of Plastic Surgery, trephining sebaceous cysts has proved advantageous on three counts : The treatment may be carried out when the patient is first seen and the delay of a long waiting list avoided. Only half of the patients treated by trephining have requested a secondary excision of the residual pit and the resultant scar is then much smaller and cosmetically more acceptable than the scar following conventional excision of the whole cyst. Operating time is saved. TECHNIQUE A 4 mm. diameter Hayes Martin skin punch, 1 an ethyl chloride spray, a spirit lamp and skin cleansing swabs are all that is needed. The skin over the cyst is cleaned and the punctum identified. The skin punch is sterilised in the flame of the spirit lamp and allowed to cool. Care being taken to guard the eyes, the skin overlying the cyst is frozen frosty white with ethyl chloride and the skin punch is used to trephine a disc of skin containing the punctum and the underlying cyst wall. The contents are expressed carefully so that the holes in the cyst and skin stay aligned. Ideally, a fringe of cyst wall protrudes through the skin hole, assuring cyst wall to skin anastomosis. Bleeding stops after a couple of minutes and a patch dressing is applied. After 3 days the patient removes the dressing and massages out any remaining cyst contents. This is repeated daily until the cyst is dry. The patient is reviewed at 3 months. Should he wish the small pit excised this is quickly and easily carried out under local anaesthesia. RESULTS In the last 6 months, 20 patients with cysts mainly on the face have been treated in this way by the author. Ten have attended for review and 5 elected to have the pit 1 Available from Chas. F. Thackray~ Leeds.

2 412 BRITISH JOURNAL OF PLASTIC SURGERY '=,,,,., i,,.. i. ),). A J J l " C FIG. I. A, Sebaceous cyst with blocked duct. t~, After trephining, the contents are expressed and the lining heals to the skin margin forming a wide " duct ". C, The cyst subsequently shrinks to a small pit.

3 T R E P H I N I N G SEBACEOUS CYSTS 413 FIG. 2. Photomicrograph of a pit 3 months after trephining a sebaceous cyst. FIG. 3. A~ Three months after trephining this pit was unacceptable and therefore excised. operative result. B~ Post-

4 414 BRITISH JOURNAL OF PLASTIC SURGERY excised. T h e r e h a v e b e e n no complications such as infection b u t one flabby cyst o f t h e scalp failed to drain satisfactorily. T w o representative cases are s h o w n in Figures 3 a n d 4. A B c D ]FIG. 4. A and B, Large cyst present for 17 years. Three weeks after ~/rephining, cyst contents were still exuding. C and D, Three months later the patient was satisfied with the small residual pit. SUMMARY T r e p h i n i n g sebaceous cysts is a simple, quick o u t p a t i e n t p r o c e d u r e a n d h a l f the patients require no f u r t h e r excision as the tiny pit that f o r m s is inconspicuous.

5 TREPHINING SEBACEOUS CYSTS 415 My thanks are due to Mr F. L. F. Innes who suggested the trial and allowed me to treat his patients. Mr Innes used this mode of treatment some years ago when faced with a patient who had so many sebaceous cysts that it woum have been a mammoth operation to excise all of them at one sitting. I am also indebted to Mr Robert Burn of the United Norwich Hospitals Department of Medical Illustration for the photographs and to his assistant, Miss Madeline Poyser, for the diagrams. REFERENCES DANNA, J. A. (1945). Simple treatment of sebaceous cysts. New Orleans Medical and Surgical ffournal, 98, 5-8. DANIqA, J. A. (1946). The treatment of sebaceous cysts by electrosurgical marsupialisation. Annals of Surgery, I23, PATTON, H. S. (1963). An alternative method for removing sebaceous cysts. Surgery Gynecology and Obstetrics, II7,