Punch Sebaceous Cyst Excision in Barpeta

A cyst is a benign (non-cancerous), round or oval-shaped lump filled with fluid and dead tissues seen anywhere in your body. When a cyst develops from the sebaceous glands, it is known as a sebaceous cyst. Sebaceous glands are oil glands that secrete a lubricating substance called sebum that covers your skin and hair. Infected sebaceous cysts are commonly removed through surgical intervention. Punch excision is a surgical method that removes a sebaceous cyst with a special punch biopsy tool. It is the most widely used cyst removal technique due to smaller incisions (cuts) with minimal scarring and trauma to the surrounding tissues.

Punch sebaceous cyst excision is a minimally invasive (does not involve extensive incisions or bleeding) surgical procedure that helps remove a sebaceous cyst. The procedure is performed under local anesthesia (a numbing agent that numbs only the part where the anesthesia is administered), using a small, rounded tool known as a punch tool or a punch biopsy tool (commonly used during punch biopsy). The punch tool pierces the top layer of the skin over the sebaceous cyst and is manually extracted or excised from the skin.
Once the cyst is removed, the surgical wound is left open with a sterile gauze packing, stitched using sutures, or filled with a skin graft (for larger cysts).

Punch excision for a sebaceous cyst is a time-saving procedure due to reduced mean operative time. This surgical technique is most often recommended:

• When other treatment methods in Barpeta, like steroid injections or drainage, fail to treat a sebaceous cyst.
• For sebaceous cysts of the back and ear.
• For cysts that are larger than 2 cm in diameter, to prevent cyst recurrence.
• If the sebaceous cyst is infected with/without pus discharge.
• When there is severe inflammation of the cyst causing pain, swelling, tenderness, and skin discoloration.
• For cosmetic reasons, when the sebaceous cyst is seen developing on the face.
• For rapidly growing sebaceous cysts that show signs of malignancy (cancer-causing ability).
• Large cysts, which have left behind enlarged, ugly-looking scars, after being surgically removed by conventional wide excision procedure.

Symptoms of a sebaceous cyst, like pain, swelling, fever, discomfort, and a visible lump, should be brought to your doctor’s notice. Your doctor will discuss your symptoms and go on to record your medical history to evaluate your general health. Inform your doctor about:

• Medical conditions like diabetes (increased blood sugar levels), hypertension (high blood pressure), asthma, blood disorders, etc. 
• History of previous surgeries, injuries, or allergies to anesthesia, latex, and other medications should also be informed to your doctor. 
• Medications being taken such as blood thinners, anti-inflammatory and anti-hypertensive drugs, antidepressants, and other herbal supplements.

Your doctor will conduct a physical examination to evaluate the cyst through digital palpation to check the cyst's size, extent, tenderness, and mobility. Infected cysts are warm to the touch, tender, and soft that may show signs of skin discoloration.

Furthermore, your doctor will order a few diagnostic tests to evaluate your general health and determine the sebaceous cyst's exact size and location. These include:

• Complete blood count- Your blood sample will be taken to check the levels of your blood components like red blood cells, white blood cells, etc. It also helps identify the presence of infection. 
• An ultrasound scan- This test uses ultrasound waves to determine the cyst's size, location, and content.
• A CT (Computed Tomography) scan- This helps to check the exact location and size of the cyst that needs to be removed and rules out the possibility of malignancy.

Preparation before punch excision

Once your doctor confirms the diagnosis and evaluates your treatment options, he/she may help you prepare for the punch excision through the guidelines below. This helps to reduce your stress and anxiety and minimize your risk of developing any complications during or after the procedure.

• You must discontinue certain medications, like blood thinners, and antidepressants, 2 weeks before the punch excision.
• You must avoid smoking and alcohol consumption 2 weeks before the procedure.
• Be sure to sign a consent form (legal permission) to allow the surgeon to perform the procedure.
• You must arrange for someone to help you drive home after the procedure.

Punch excision for a sebaceous cyst is a minimally invasive and outpatient procedure. You do not require any hospitalization and will be sent home the same day. The procedure usually takes around 15 to 30 minutes, depending on the size and severity of the sebaceous cyst. It is performed by a dermatologist (a doctor specializing in the disorders of skin, hair, and nails) or a general surgeon (a doctor who specializes in the surgical treatment in Barpeta of body tissues to treat medical conditions). The procedure involves the following steps:

Preparing the surgical site

• Your nurse in charge will check your vitals (blood pressure, pulse, heart rate, sugar levels, etc.) before taking you to the operating room.
• Your nurse will disinfect the area around the cyst using an antiseptic solution to remove surface contaminants. This helps to prevent post-op infection.
• Your surgeon will identify the cyst and mark the area for the procedure (for inserting the punch tool).

Anesthesia 

• Your surgeon will administer local or topical anesthesia through injection, spray or creams in the skin around your cyst. 

Incision

• Your surgeon will use a special punch tool that is sharp and circular, an apple core-like instrument, and inserted into the cyst near the punctum (the most prominent part of the cyst).

Cyst removal

• Your surgeon will rotate the punch tool clockwise and anticlockwise and retract or pull out the tool carefully. 
• The depth of the tissue cut out through the punch tool is usually less than 4 mm in diameter and about 1.5 mm deep.
• A surgical instrument called blunt forceps will be used by your surgeon to remove the cutout tissue from the cyst.
• Your surgeon will squeeze out the cyst content through manual/digital compression.

Wound closure

• Once the cyst content is completely removed, your surgeon will leave the wound open to heal, pack it with a medicated gauze, close it with a stitch, or place a graft (taken from behind the ear or ear lobe) over the surgical wound. Graft placement is usually recommended for larger cysts that may leave behind a large opening after cyst removal.

Surgical dressing

• Your surgeon will place a surgical dressing on your wound that helps heal and protects against any infection or injury.

After the procedure, the nurse will shift you to the recovery room, where your vitals will be monitored.

Immediately after the excision

• You may experience mild pain and discomfort, which will resolve over a period of time with the help of painkillers prescribed by your surgeon.
• You will be sent home after a couple of hours post-excision, where you need to spend your day resting. This allows your body to heal. 
• Your surgeon will also prescribe antibiotics to prevent the risk of post-op infection.

At home

• Keep your surgical site clean and dry by changing the dressing every alternate day until it heals.
• Avoid scratching or rubbing your surgical site, which can lead to injury and secondary infection.
• Avoid swimming, saunas, and tub baths for at least 2 to 3 weeks after the excision tp prevent soaking the wound.
• Refrain from direct exposure to sun or dust for the initial few days following the excision.
• It is normal to experience some discharge from the surgical wound, which will resolve as it heals.

1-week post-excision

• A scab tissue will form 7 to 10 days after the punch excision, which will fall off, and new skin will start forming after 10 to 14 days.
• Avoid strenuous activities and lifting heavy objects at least 2 weeks post-procedure.

Recovery 

• Complete healing and recovery may usually take around 1 to 2 weeks, depending on the size and location of the cyst.

Punch sebaceous cyst excision is a popular surgical technique used to remove a sebaceous cyst using the principles of a punch biopsy. The excision is associated with the following benefits and risks.

Benefits

• The punch or stab incision is usually 1/3rd the size of the cyst. Smaller incisions involve minimal bleeding. 
• Punch excision involves minimal scarring since no stitches are involved most of the time.
• It minimizes the post-op complications as seen in a wide-open surgical cyst removal. 
• The duration of the procedure is significantly reduced.
• Recovery is quick for faster healing. 

Risks

• Local bleeding and bruising.
• Wound infection with/without pus discharge, other infection-related symptoms such as high-grade fever (>103), body pain, chills, etc. 
• Allergic reactions to anesthesia cause skin rashes, hives, itching, discoloration, nausea, vomiting, dizziness, confusion, and breathing difficulties.
• High risk of cyst recurrence, possibly due to smaller incisions that compromise the visibility during the procedure.
• Damage to the structures beneath the skin layer, such as an artery or nerve injury.
• Areas of hypopigmentation or hyperpigmentation due to scar formation.

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