Incision and Drainage (I&D) of an epidermoid cyst is a common minor surgical procedure to relieve discomfort and prevent infection in a cyst that has become inflamed or infected. Hereโs an overview of how the procedure is typically done:
Indications for I&D:
- Infected or inflamed epidermoid cyst.
- A cyst that is painful, swollen, or growing.
- A cyst that has ruptured and is draining pus.
- A cyst causing cosmetic concerns.
Steps for Incision and Drainage:
- Preparation:
- Informed consent: The patient is informed about the procedure, its risks, and potential complications (e.g., scarring, recurrence, or infection).
- Sterile environment: The procedure is typically done in a clean, sterile environment, like a doctor’s office or clinic.
- Local anesthesia: The area around the cyst is numbed using a local anesthetic (like lidocaine) to ensure that the patient doesnโt feel pain during the procedure.
- Incision:
- Once the area is numbed, a scalpel is used to make a small incision (usually over the top of the cyst) to allow drainage of its contents.
- If the cyst is infected, there may be pus or thick fluid released.
- Drainage:
- The cyst contents (keratin and other materials) are gently squeezed out or evacuated using forceps or by applying pressure to the area.
- The contents can vary from a thick, cheesy substance to a more liquid consistency, depending on the type of cyst.
- Removal of Cyst Lining (Optional):
- To reduce the chance of recurrence, the cyst lining may be removed if it’s accessible. This is a more involved step, usually done under sterile conditions. If the lining isn’t removed, the cyst could recur over time.
- Sometimes, the lining is not entirely removed in an office setting, and itโs left to heal by secondary intention.
- Post-procedure care:
- The incision is typically not sutured closed to allow continued drainage, especially if it was infected. In some cases, a small drain may be placed to allow continued drainage.
- The area is cleaned, and a sterile dressing is applied.
- The patient may be prescribed antibiotics if there was infection, and instructions for proper wound care are provided to prevent further infection.
- Follow-up:
- A follow-up appointment is often scheduled in a few days to check the healing process.
- If the cyst recurs, another procedure may be necessary, especially if the cyst lining wasn’t removed during the first I&D.
Risks and Complications:
- Infection: The incision site may become infected if proper care isnโt taken.
- Scarring: The incision may leave a scar, especially if the cyst was large.
- Recurrence: If the cyst lining isn’t fully removed, it could refill and recur.
- Bleeding: Minor bleeding is possible, though significant bleeding is rare.
In general, I&D of an epidermoid cyst is a safe and effective way to manage an inflamed or infected cyst, but follow-up care and proper wound care are essential to ensure proper healing.
