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Medical Forum / General / General / May 2007

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infectious sebacious cyst

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MZB - 26 May 2007 18:23 GMT
OK-- I've had this sebacious cyst (back of neck/upper back) for maybe 10
years. It has gotten quite large.

Over the last week (especially last 2-4 days) it got really bad. Very
painful, red, and almost doubled in size (over 2 inches now).

It got so painful I went to urgent care place this morning (wonderful timing
for these things as my regular physician is out of town for a week).

Anyway, the doctor at Urgent Care said it was infected. He lanced it and
spent a lot of time squeezing contents. He did state he even got part of the
shell wall. He packed the wound and I will have to keep going back for
awhile to get the packing/wick changed (every 2-3 days or so). He also put
me on antibiotics (cephalexin for 10 days)

My question/concern: I have to be out-of-town starting 6/11 on business for
10 days. Is it likely that the wound will basically be healed by then and I
will be done getting packing changed? Right now the local anesthesia is
wearing off and it hurts quite a bit.

Any suggestions?

Mel
Howard McCollister - 26 May 2007 19:10 GMT
> OK-- I've had this sebacious cyst (back of neck/upper back) for maybe 10
> years. It has gotten quite large.
[quoted text clipped - 20 lines]
>
> Mel

It's unlikely that it will be completely healed by 6/11, but it will likely
be shallow enough that it won't require packing, or anything more
complicated than just putting a dressing on it (more to protect your
clothing than anything else). If  *all* of the cyst wall isn't removed, and
that's almost impossible when a sebaceous cyst is infected, then it's very
likely that the cyst will ultimately recur. At some point in the future,
you'll will likely have to have it reoperated on to remove the entire thing
or you will likely have to go through this whole thing again.

HMc
MZB - 27 May 2007 04:13 GMT
Yes, I was told that I would need to get it totally out once things settled
down.

Question, Howard:  Right now it hurts and is seeping blood somewhat. Also,
while the size has been somewhat reduced, it is still somewhat large (I'd
say 50% of what it was when I had it lanced).

Does the seeping lesson while we are still packing it? Also, will the size
decrease?

Mel

>> OK-- I've had this sebacious cyst (back of neck/upper back) for maybe 10
>> years. It has gotten quite large.
[quoted text clipped - 31 lines]
>
> HMc
Howard McCollister - 27 May 2007 12:46 GMT
> Yes, I was told that I would need to get it totally out once things
> settled down.
[quoted text clipped - 5 lines]
> Does the seeping lesson while we are still packing it? Also, will the size
> decrease?

Most likely the size of it, now that it's drained, is due to inflammation
and induration of the surrounding tissue as a result of the infection. That
will decrease pretty rapidly now that the absess is drained and the
infection resolved. That inflamed tissue will seep serum, and it will seep
blood because that inflammed tissue is fragile, and it's painful. Likewise,
that will decrease over the next several days as the inflammation resolves.

The packing is placed for two reasons - 1) to minimize oozing of blood for
the first couple of days after it's drained and 2) to hold the absess cavity
open so that the skin doesn't heal before the cavity is closed. As the
induration and inflammation go down over the next several days there will be
less oozing of blood. The cavity will remain open as the cavity granulates
( http://en.wikipedia.org/wiki/Granulation_tissue ) . That granulation
tissue will be kind of fragile and will ooze serum in modest amounts. At the
point that that granulation tissue forms, there will be no need to pack the
wound. To get to that point will take about 10 days - 2 weeks from time it
was drained. Once that heals and the skin is closed, I would pretty much
ignore it for a long time, until the surrounding tissue is completely
normal.

Complete excision of the cyst can wait until it re-forms (if it does) and
it's margins are readily definable. That will make for a more accurate and
smaller excision. Excision of sebaceous cysts of the back, in the location
you describe, are more difficult because the skin of the upper back is so
thick compared to other parts of the body.

HMc
MZB - 27 May 2007 17:16 GMT
Howard:

Thanks for responding again; you are always so gracious with your time on
this BB.

Still a few questions: The doctor said I could take a shower, so I did. But
even coming out of the shower, it was quite bloody. I am wondering if I
shouldn't forego showering the next few days.

Also, things are still very swollen. I suspect there is still plenty of
cyst material that didn't get squeezed out as it was such a large cyst.
Should that be a concern or will it just eventually come out or get
reabsorbed?

I go tomorrow to have the packing changed. Is it typical to do more
"squeezing of contents" at that time? I suspect the removal and repacking
will be quite painful but won't take long. Am I correct?

You mentioned leaking serum/blood. The leakage seems to be about 75% blood
but surrounding yellowish fluid. I assume that is pus or is that serum?

The appearance is still worrisome. Before the surgery it was the size of a
snall lemon; it is now I would say a large walnut (loosely speaking; it is
diffuse).

I guess I have to keep in mind that the lancing was done just 24 hours ago!

Mel

>> Yes, I was told that I would need to get it totally out once things
>> settled down.
[quoted text clipped - 34 lines]
>
> HMc
Howard McCollister - 27 May 2007 20:11 GMT
> Howard:
>
[quoted text clipped - 25 lines]
>
> Mel

Showering won't hurt the recovery process at all. Cyst contents left behind
will make no difference. Your doctor may make more attempts at getting more
stuff out when he changes the packing, but squeezing would be unnecessarily
painful. Gentle irrigation is all that would be required. Re-packing might
be painful, but there's no point in really trying hard to stuff it in there.
At this point it's just there to keep the cavity open, so putting it in
gently and loosely is all that's necessary and will be far less painful for
you.

Your description sounds like a very typical course so far for this
situation.

HMc
MZB - 27 May 2007 23:03 GMT
Thanks. You are a patient man!!!

Mel

>> Howard:
>>
[quoted text clipped - 40 lines]
>
> HMc
MZB - 28 May 2007 19:07 GMT
I went to see doctor  today for the first changing of the wick. He took out
the old wick. He did emphasize that this was a huge cyst/cavity. But he
thinks it is doing well. He says there are now no signs of infection. Some
pink but no red areas.

After removing the wick he did a lot of squeezing trying to get more crap
out. He used forceps too-- it was painful but tolerable. He says he got more
stuff out. He irrigated also and repacked. He says it took six inches of
packing and that's why it looks so swollen to me. It is swollen, but
apparently not nearly as bad as I think (looked walnut-sized this morning).
Next changing of the packing will be Thursday.

I am supposed to leave in 2 weeks and he seems hopeful that by then I'll
only need to change smaller bandages and no wick will be needed.

Mel

>> Howard:
>>
[quoted text clipped - 40 lines]
>
> HMc

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