This healthy lady presented with a painful swelling on the posterior aspect of her left shoulder. This had been present for one week.
Eight years previously she had had a very large infected sebaceous cyst in the same area and this had now recurred.
The original operation was performed under Local Anaesthetic in the office. With these large infected sebaceous cysts they are often associated with an abscess and the cyst wall is necrotic.
Primary complete excision of the infected cyst in the office is difficult because a fairly extensive operation needs to be undertaken under Local Anaesthetic and complete excision of the cyst would lead to bleeding, hard to control in the office setting.
A more conservative approach as was carried out on both occasions in this case, is to drain the abscess and then remove the fragments of the cyst wall piecemeal. Through the small incision in these cases it is difficult to be sure that all the fragments are removed and to do so would entail increasing amount of Local Anaesthetic and further risk of bleeding.
Thus the wound is packed and two or three days later the patient returns - feeling much better. The pack is removed and the pus then drained out again and by this time the cyst wall fragments are free and can be picked out with a cotton bud with very little pain and no need for local anaesthesia. This can be repeated on a couple of occasions.
The wound then heals by second intention healing.
The patient is warned that the cyst may recur because the small fragments can lead to further growth of the cyst. A type of implantation dermoid cyst. The patient is warned to come back when and if the cyst recurs.
Thus in summary very large infected sebaceous cysts can be dealt with in the office by more conservative techniques rather than hospital admission, General Anaesthetic and extensive surgery in an infected area.