Procedure
- Mark the site of the incision.
- Apply iodine to the surgical area.
- Cover with a sterile fenestrated drape.
- Establish a field block around the cyst [Figure 10] and a depot under the cyst to elevate it [Figure 11].
Figure 10
Figure 11
- Make an elliptical incision across the cyst with the longest axis parallel to the skin lines [Figure 78]. Ensure that the opening to the sebaceous gland lies within the surgical margins.
- If the skin covering the cyst is very thin (e.g. scrotum), you can avoid rupturing the cyst wall by making the incision alongside the cyst.
Figure 78
- Make the incision large enough that the keratinous cyst can be removed completely.
- Grip the skin flap containing the cyst with the surgical tweezers (do not grip the cyst itself, because you may perforate it).
- Dissect the cyst from its surroundings using blunt and sharp instruments [Figure 79], keeping the tweezers perpendicular for traction [Figure 80].
Figure 79
Figure 80
- If you do not succeed in removing the cyst with its wall intact and it ruptures instead, grip the remains of the cyst wall in the Kocher forceps and dissect it with sharp scissors.
- Deposit the keratinous cyst in a container filled with formalin 10%.
- Bind or coagulate blood vessels if necessary, to establish haemostasis.
- Suture the skin with non-reabsorbable material. In some cases (scrotum), a suture strip may suffice.
- Apply a wound covering bandage or, if necessary, a pressure bandage.