From the Guidelines
Wound packing after incision and drainage (I&D) of non-infected epidermal cysts is generally unnecessary, and primary closure with sutures is the preferred approach. This is based on the principle that complete removal of the cyst wall prevents recurrence, and primary closure leads to better cosmetic outcomes and faster healing 1. For non-infected epidermal cysts, the goal is to remove the cyst wall completely, rather than leaving an open wound that requires packing.
Key Considerations
- The evidence from 1 suggests that simply covering the surgical site with a dry dressing is usually the easiest and most effective treatment of the wound, although some clinicians pack it with gauze or suture it closed.
- The study 1 discusses the management of anorectal abscesses, which may not be directly applicable to epidermal cysts, but it highlights the importance of complete drainage and the lack of clear evidence supporting the use of wound packing.
- The most recent and highest quality study 1 does not provide a clear recommendation for wound packing after I&D of anorectal abscesses, let alone non-infected epidermal cysts, emphasizing the need for individualized treatment decisions.
Clinical Implications
- If the cyst was completely excised with its capsule intact, the wound can be closed primarily with non-absorbable sutures like nylon or polypropylene (4-0 or 5-0 for facial areas, 3-0 or 4-0 for the trunk or extremities), which should be removed in 5-7 days for the face and 10-14 days for other body areas.
- Wound packing is more commonly indicated for abscesses or infected cysts where there is concern about trapping bacteria in a closed space, which could lead to recurrent infection.
- The rationale behind avoiding packing for clean epidermal cyst excisions is that these are sterile procedures when the cyst is not infected, and primary closure promotes faster healing with better cosmetic results while reducing the need for wound care and follow-up visits 1.
From the Research
Wound Packing after I&D of Non-Infected Epidermal Cyst
- The current evidence on wound packing after incision and drainage (I&D) of non-infected epidermal cysts is limited, but some studies provide insights into the management of similar conditions, such as skin abscesses 2, 3.
- A study on the treatment of skin abscesses found that wound packing did not significantly impact the failure or recurrence rates after I&D, and that packing groups had more pain 2.
- A randomized trial comparing wound packing to no wound packing after I&D of superficial skin abscesses in the pediatric emergency department found similar failure rates and no significant difference in pain scores between the two groups 3.
- Another study on epidermoid cysts found that the complication rate after surgical treatment was low (2.2%), and that complete removal of the cyst wall was necessary to avoid relapses 4.
- A retrospective chart review of inflamed epidermal inclusion cysts found that almost half of the cases cultured did not grow pathogenic bacteria, suggesting that incision and drainage with culture and appropriate therapy may be a viable option in uncomplicated cases 5.
- A study on factors affecting complications after treatment of epidermal cysts found that postoperative complications occurred when the excision of the epidermal cyst was performed at preoperative infection sites or at sites with high tension, highlighting the importance of careful postoperative care 6.