From the Guidelines
Packing a sebaceous cyst after incision and drainage (I&D) is generally not recommended. After draining a sebaceous cyst, the cavity should typically be left open without packing to allow for continued drainage and healing from the inside out. Unlike abscesses, sebaceous cysts have a distinct wall or sac that needs to be completely removed to prevent recurrence. If the cyst wall remains after I&D, the cyst will likely return regardless of packing. The preferred treatment for sebaceous cysts is complete surgical excision of both the contents and the entire cyst wall. If I&D is performed as a temporary measure for an infected sebaceous cyst, the area should be cleaned, drained, and left open with instructions for warm compresses and keeping the area clean. Antibiotics may be prescribed if there are signs of surrounding cellulitis. The patient should be advised that definitive treatment with complete excision will likely be needed once the acute infection resolves to prevent recurrence. Packing can actually interfere with proper healing of sebaceous cysts and may increase discomfort without providing significant benefit.
Some studies, such as 1, discuss the role of wound packing after surgical drainage of anorectal abscesses, but the evidence is not directly applicable to sebaceous cysts. However, it is worth noting that even in the context of anorectal abscesses, the use of packing is not universally recommended and its benefits are unclear, as stated in 1 and 1. The focus should always be on preventing recurrence and promoting proper healing, which in the case of sebaceous cysts, typically involves complete excision rather than packing after I&D.
In terms of managing sebaceous cysts, the key considerations include:
- Complete removal of the cyst wall to prevent recurrence
- Temporary measures like I&D for infected cysts, with the understanding that definitive treatment will be needed later
- Use of antibiotics if there are signs of surrounding infection
- Patient education on the need for follow-up and potential for recurrence without complete excision
Given the available evidence and focusing on the best outcomes in terms of morbidity, mortality, and quality of life, the most appropriate approach is to avoid packing sebaceous cysts after I&D and instead focus on complete excision as the definitive treatment.
From the Research
Packing a Sebaceous Cyst after Incision and Drainage
- There is no direct evidence in the provided studies that discusses packing a sebaceous cyst after incision and drainage 2, 3, 4.
- The studies focus on different methods of treating sebaceous cysts, such as suture closure 2, incisional techniques 3, and minimal excision techniques 4.
- None of the studies mention packing as a step in the treatment process, suggesting that it may not be a common practice in the management of sebaceous cysts.
- The minimal excision technique described in 4 involves expressing the cyst contents and extracting the cyst wall, but does not mention packing the cavity.
- The study on suture closure 2 discusses closing the wound with prolene sutures, but does not mention packing the area after incision and drainage.