Incision, draining and exteriorization techniques Flashcards Preview

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Flashcards in Incision, draining and exteriorization techniques Deck (85):
1

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

F

2

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

T

3

Lipomas are not usually encapsulated

F They usually are

4

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

T

5

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

T

6

Lipomas frequently become inflamed

F

7

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

T

8

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

F Vertical if possible.

9

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

T

10

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

F Start if cyst inflamed.

11

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

T

12

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.

T

13

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

T

14

Treated milia tend to recur.

F

15

Pilar cysts more commonly require removal of redundant overlying skin.

T

16

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

T

17

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

T

18

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

F Exteriorisation of cysts and sinus tracks.

19

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

F Leave to heal by second intention if possible.

20

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

T

21

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

T

22

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

T

23

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.

T

24

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

T

25

Packing of wounds can be performed with iodoform or plain gauze

T

26

Scrotal cyst excision sites generally heal faster.

F Slower – leave sutures in longer.

27

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

F 72-96hrs.

28

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

T

29

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

T

30

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

T

31

Medical treatment of hidradenitis suppurativa is topical antibiotics only

F Topical and oral Abx

32

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

T

33

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

F Secondary intent, large defects are left to granulate

34

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

F Radius

35

Under no circumstances should a cyst be decompressed

F

36

Lipomas on the forehead are often underneath the frontalis muscle

T

37

Lipomas are non-encapsulated subcutaneous lesions

F encapsulated

38

Most lipomas are asymptomatic

T

39

Lipomas rarely become inflamed

T

40

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

T

41

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

T

42

Inject the LA in the lipoma

F

43

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

T

44

Injecting the LA around the lesion may help it get dissected

T

45

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

T

46

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

F
lateral

47

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

T

48

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

T

49

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

F
vertically

50

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

T

51

Intermuscular lipomas are poorly demarcated

F
intramuscular are

52

Intramuscular lipomas are firmer than normal lipomas

T

53

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

T

54

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

False
equal to the radius

55

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

F
Gardners and Gorlins

56

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

T

57

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

T

58

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

F – staph and strep

59

Trichilemmal cysts are more commonly seen in men than women

F

60

Trichelemmal cysts often have a punctum

F

61

Pilar cysts have a thick wall

T

62

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

T

63

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

T

64

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

T

65

The pilar cyst is the true sebaceous cyst

F
steatocystoma is

66

The most common site of a steatocystoma is the scalp

F
sternum

67

Steatocystomas often have an overlying pore

F

68

Steatocystomas may be associated with surrounding open comedones

T

69

Apocrine hidrocystomas are usually in the periocular area

T

70

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

T

71

BCCs are softer and smoother than hidrocystomas

F

72

Topical antibiotics are not recommended for removal of periocular lesions

F

73

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

F
lower pH

74

Infected cysts may require packing or a wound drain

T

75

Packing can be performed with iodoform or plain gauze

T

76

Broad spectrum Abs should be given after I&D

T

77

Medical treatment of hidradenitis suppurative includes topical and oral abs

T

78

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

F secondary

79

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

F
secondary

80

Large lesions should be allowed to granulate

T

81

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

T

82

Epidermoid cysts are easier to remove than steatocystomas

F

83

Scrotal cysts/lesions may require fusiform excision

T

84

Scrotal lesions heal quickly

F
slow

85

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

F
medial rotation