The difference between Surgical Cyst Removal and Incision and Drainage of Infected Cyst

With regards to cyst treatment, we often hear the terms Surgical Removal and Incision and Drainage. But what do they mean and how do I know which treatment is best for me?

Cyst treatment is curated in accordance with the state of the cyst. In other words, there are different treatments for infected and non-infected cysts. For infected cysts, the treatment is called incision and drainage, and for non-infected cysts, the treatment is surgical cyst removal.

Infected cysts: Incision and Drainage
Cysts located in areas that are prone to friction or minor trauma, are at risk of developing infection. Severe or untreated infections can result in the formation of abscess. Abscess is an infection, characterised as a confined painful collection of pus, surrounded by inflamed tissue.

Infection to a sebaceous cyst is usually due to a bacterial infection. If caught early, a course of antibiotics may be enough to treat the infection, preventing abscess development. However, in most cases, when abscess has developed, an incision and drainage procedure is required.

Incision and drainage procedure is performed to treat abscess of cysts. It is performed under local anaesthetic, where an incision is made over the abscess to release and drain the pus, with minimal scarring. Once drained, the cavity is internally cleaned in attempts to eradicate as much infection as possible.

An incision and drainage procedure can take up to 45 minutes depending on the size and complexity of the cyst. As it is performed under local anaesthetic, you can go home after the procedure and return to your normal activities. It is however advised to keep the wound dry for quick and effective healing.

It is also important to note that, when infected, the skin PH changes and the local anaesthetic does not work as well. Incision and drainage procedures are usually uncomfortable for the patient, hence it is always best to remove the cyst before it gets infected.

In rare cases – typically larger cysts – the now emptied wound is packed to prevent abscess reoccurring and allows for further drainage of infection. However, with smaller cysts, wound packing is not always necessary. Wound packing allows for the wound to heal by secondary intention, which means the wound heals from the inside out.

Non-infected Cysts: Surgical Cyst Removal
Skin cysts can be divided into Sebaceous Cysts and Epidermoid Cysts. Sebaceous cysts are typically filled with sebum, an oily and waxy substance secreted by sebaceous glands functioning to coat and protect the skin. Whereas an Epidermoid cyst is usually filled with a white substance called keratin: a protein involved in skin strength and flexibility.

Sebaceous and Epidermoid cysts have cystic sacs, in which sebum and keratin reside in respectively. Surgical Cyst Removal involves the removal of the entire cystic sac. By removing the sac in whole, the chances of the cyst recurring are low. Incomplete removal of the cyst sac allows for the sac to reform and refill, hence why you should not try to pop your cyst.

Surgical Cyst Removal is also performed under local anaesthetic – duration up to 45 minutes. A small incision is made to the cyst to ensure minimal scarring. Once the entire sac is removed, the small scar is closed using non-dissolvable sutures and covered with a plaster.

Summary
Active infections increase the complexity of treatment. Complete surgical removal is not achievable on infected cysts. Instead, incision and drainage is performed. Cysts that are not infected can undergo Surgical Cyst Removal, a quick and simple surgery with minimal scarring.