be forwarned, this post is not for the squimish. if you have a weak heart, constitution or bladder. go away now.
so. here's what i'm doing on my birthday this year....having a cyst removed. it's gotten so huge and painful i don't want to put it off for another minute. i was supposed to have it removed last thursday, but as i was chatting with the doc while he was shooting my back up with novicane type stuff, i mentioned i was going camping. he didn't want to do slice into my back and then have me out in the woods, so there i am with about seven needle pokes in my back and we stop.
and guess what? it seems the needle pokes aggrivated the cyst and now it's .......gross and painful. really painful. so i moved my rescheduled appointment from the 9th to the 5th.
here's my birthday fun:
Nonsterile Tray for Anesthesia
Place the following items on a nonfenestrated drape covering a Mayo stand:
Nonsterile gloves and mask
1 inch of 4 X 4 gauze soaked with povidone-iodine solution
1 inch of 4 X 4 gauze
5-mL syringe, filled with 2 percent lidocaine with epinephrine (Xylocaine with epinephrine) with a 30-gauge needle
25-gauge, 1¼-inch needle (for anesthetizing beneath the cyst)
Sterile Tray for the Procedure
Place the following items on a sterile drape covering a Mayo stand:
Fenestrated disposable drape
Two sterile bandages to anchor the drape
Three small-tipped hemostats (mosquito clamps)
No. 11 blade
Needle holder for suturing (if needed)
2 inches of 4 3 4 sterile gauze
Suture materials (if needed)
Splatter control shield (if desired)
Some physicians use the nonsterile gloves that were used to administer the anesthesia for the removal of small or superficial cysts.
FIGURE 1. Incision in the top of a cyst with a no. 11 blade. The cyst is squeezed to remove all of the cyst contents. A hemostat can be placed in the incision and the blades opened while the cyst is squeezed to facilitate removal of the cyst contents.
FIGURE 2. After vigorous squeezing, removing the cyst contents and loosening the cyst wall from the surrounding tissue, a hemostat is placed in the wound, and the entire cyst wall is gently delivered through the small incision.
The skin overlying the site is cleansed with povidone-iodine solution. The skin overlying the cyst and the tissue to the sides and beneath the cyst are anesthetized with 2 percent lidocaine with epinephrine.
A fenestrated drape can be placed on the patient, with the lesion beneath the fenestration. A no. 11 blade is used to create a stab incision into the center of the cyst. A small-tipped hemostat is placed into the cyst, the tips gently opened and compression applied to allow the cyst contents to pass through the opening (Figure 1).
The hemostat can be removed, and both thumbs are used to express the cyst contents. Gauze or a splatter shield can be used to shield the physician from splatter. The hemostat can be reinserted, if needed, to assist with passage of the sebaceous material.
Following vigorous and complete expression, the hemostat is reintroduced into the cyst cavity, and the capsule at the base of the wound is grasped and elevated. An attempt should be made to gently remove the entire sac through the small opening (Figure 2). The sac may break, and several pieces may need to be removed.
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so, if you're still here and reading, you are amazingly strong and not easily grossed out. let's go shoot oysters.