Incision, draining and exteriorization techniques Flashcards

1
Q

Tumescent anaesthesia should not be used when removing larger cysts and lipomas.

A

F

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2
Q

The incision for removal of a lipoma should be one-half to one-third of the lesional diameter of the underlying lipoma.

A

T

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3
Q

Lipomas are not usually encapsulated

A

F They usually are

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4
Q

Lipomas will usually be lighter in colour and firmer than the surrounding adipose tissue.

A

T

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5
Q

Infiltrating lipomas frequently require an incision which is larger than for ordinary lipomas.

A

T

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6
Q

Lipomas frequently become inflamed

A

F

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7
Q

For lipoma removal local anaesthetic is injected over and around and under the lesion

A

T

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8
Q

When removing forehead lipomas, the frontalis muscle bundles should be dissected in a horizontal orientation.

A

F Vertical if possible.

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9
Q

After removal of an epidermal cyst, the wound should be irrigated with saline.

A

T

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10
Q

There is no indication to start antibiotics when excising epidermal cysts.

A

F Start if cyst inflamed.

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11
Q

Multiple epidermal cysts may be associated with Gardner syndrome and basal cell nevus syndrome

A

T

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12
Q

If considerable fibrosis is encountered during removal of a cyst, the best course is to perform a fusiform excision including the fibrotic area and underlying cyst.

A

T

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13
Q

When infiltrating local anaesthetic during epidermal cyst removal, avoid direct injection into the cyst cavity to prevent distention and possible rupture.

A

T

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14
Q

Treated milia tend to recur.

A

F

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15
Q

Pilar cysts more commonly require removal of redundant overlying skin.

A

T

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16
Q

Carbon dioxide laser can be used to exteriorize and destroy steatocystomas.

A

T

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17
Q

Local anaesthesia is often less effective in infective tissues because of the low pH of infected tissues.

A

T

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18
Q

Incision and drainage of inflammatory lesions is considered the preferred surgical treatment method for hidradenitis suppurativa.

A

F Exteriorisation of cysts and sinus tracks.

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19
Q

Unroofed areas left after surgical management of HS should be grafted.

A

F Leave to heal by second intention if possible.

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20
Q

Infiltrating lipomas and forehead lipomas are much deeper than they appear and are often under or between muscle.

A

T

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21
Q

Cysts which have been drained previously or which have been traumatised will often have significant scar tissue associated with them.

A

T

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22
Q

Infiltrating local anaesthetic in and around a cyst helps to dissect it free from the surrounding tissue.

A

T

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23
Q

After incision and drainage of an abscess, a wick of material can be left extruded from the gauze packing – this should be advanced approximately 1 cm per day with each dressing change until it is removed.

A

T

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24
Q

Once a cavity of an infected cyst has been irrigated with saline a decision is made whether packing the wound or insertion of a drain is necessary

A

T

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25
Q

Packing of wounds can be performed with iodoform or plain gauze

A

T

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26
Q

Scrotal cyst excision sites generally heal faster.

A

F Slower – leave sutures in longer.

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27
Q

If drains are used after the removal of a subcutaneous lesion, these are typically removed in 24 hours.

A

F 72-96hrs.

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28
Q

CT or MRIs should be performed pre-operatively for infiltrating lipomas to determine the extent of involvement.

A

T

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29
Q

In removing milia, steatocystomas and apocrine hidrocystomas, minimal surgery should be done to avoid possible excess scar formation.

A

T

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30
Q

Scrotal cysts may be calcified and more fibrotic, lending themselves to fusiform excisions.

A

T

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31
Q

Medical treatment of hidradenitis suppurativa is topical antibiotics only

A

F Topical and oral Abx

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32
Q

In hidradenitis suppurativa exteriorization of cysts and sinus tracts is considered the preferred method of treatment

A

T

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33
Q

After surgical treatment of hidradenitis suppurativa the wound is closed with primary closure

A

F Secondary intent, large defects are left to granulate

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34
Q

For cysts and lipomas make an initial incision equal to the diameter of the lesion

A

F Radius

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35
Q

Under no circumstances should a cyst be decompressed

A

F

36
Q

Lipomas on the forehead are often underneath the frontalis muscle

A

T

37
Q

Lipomas are non-encapsulated subcutaneous lesions

A

F encapsulated

38
Q

Most lipomas are asymptomatic

A

T

39
Q

Lipomas rarely become inflamed

A

T

40
Q

Lipomas on the upper extremities may be deep and involve the muscles and neural and vascular structures

A

T

41
Q

The incision length of a lipoma should be ½-1/3 of the lesion diameter

A

T

42
Q

Inject the LA in the lipoma

A

F

43
Q

Inject the LA over, around and under the lipoma or cyst

A

T

44
Q

Injecting the LA around the lesion may help it get dissected

A

T

45
Q

Blunt dissection of a lipoma via a haemostat, Ragnel or Metzenbaum

A

T

46
Q

Apply vertical compression to enable lipoma to squeeze it through the incision line

A

F

lateral

47
Q

If drains are used should be removed in 72-96 hours

A

T

48
Q

The supratrochlear and supraorbital nerve bundles may be injured if care is not taken during removal of a lipoma of the forehead

A

T

49
Q

In order to access a frontalis associated lipoma, the frontalis muscle is dissected horizontally to separate the muscle fibres

A

F

vertically

50
Q

A pressure dressing is helpful post removal of a frontalis associated lipoma

A

T

51
Q

Intermuscular lipomas are poorly demarcated

A

F

intramuscular are

52
Q

Intramuscular lipomas are firmer than normal lipomas

A

T

53
Q

If a lipoma is located near Erb’s point, a nerve stimulator should be used

A

T

54
Q

The initial incision for removal of a cyst or lipomas is half the radius of the lesion

A

False

equal to the radius

55
Q

Multiple epidermoid cysts is associated with Cowden’s syndrome and Gorlins

A

F

Gardners and Gorlins

56
Q

When excising an epidermoid cyst, make the incision line through the epidermal pore

A

T

57
Q

The incision line can be made into a fusiform excision if there is significant fibrosis or scar

A

T

58
Q

Oral abs that cover pseudomonas should be given when excising cysts that are mildly inflamed

A

F – staph and strep

59
Q

Trichilemmal cysts are more commonly seen in men than women

A

F

60
Q

Trichelemmal cysts often have a punctum

A

F

61
Q

Pilar cysts have a thick wall

A

T

62
Q

The inelastic nature of the scalp makes undermining and closing the dead space more difficult

A

T

63
Q

There may be a fibrous capsule at the lateral margin surrounding the lesion

A

T

64
Q

The thick wall allows the pilar cyst to be easily delivery through the incision

A

T

65
Q

The pilar cyst is the true sebaceous cyst

A

F

steatocystoma is

66
Q

The most common site of a steatocystoma is the scalp

A

F

sternum

67
Q

Steatocystomas often have an overlying pore

A

F

68
Q

Steatocystomas may be associated with surrounding open comedones

A

T

69
Q

Apocrine hidrocystomas are usually in the periocular area

A

T

70
Q

The blue discolouration of an apocrine hidrocystomas is due to the tyndall phenomenon, extravasated rbcs, and lipofuscin

A

T

71
Q

BCCs are softer and smoother than hidrocystomas

A

F

72
Q

Topical antibiotics are not recommended for removal of periocular lesions

A

F

73
Q

Infected tissues have a higher pH and therefore LA is less effective

A

F

lower pH

74
Q

Infected cysts may require packing or a wound drain

A

T

75
Q

Packing can be performed with iodoform or plain gauze

A

T

76
Q

Broad spectrum Abs should be given after I&D

A

T

77
Q

Medical treatment of hidradenitis suppurative includes topical and oral abs

A

T

78
Q

The primary cause of problems in HS is the inflammation of apocrine, eccrine and sebaceous glands

A

F secondary

79
Q

The exteriorization of cysts and sinus tracts should be allowed to heal by primary intention

A

F

secondary

80
Q

Large lesions should be allowed to granulate

A

T

81
Q

When I&D milia, the cyst wall will often be extruded with the keratinous contents

A

T

82
Q

Epidermoid cysts are easier to remove than steatocystomas

A

F

83
Q

Scrotal cysts/lesions may require fusiform excision

A

T

84
Q

Scrotal lesions heal quickly

A

F

slow

85
Q

Injury to the brachial plexus may result in shoulder droop and the hand rotated laterally

A

F

medial rotation