Dr. Geoff Butler

This one was a bit more complicated and therefore took a bit longer, for which I apologize. We did have more hands available for this procedure so we were able to use retractors which certainly help at times. I'm still using a very basic set-up and I wish there were more direct views I could share with you but I'll have to work on that moving forward. Overall things went well and the cyst was removed in it's entirety. Have a nice weekend! 0:00 Intro 1:33 Initial Incision 10:40 Cyst Rupture 12:50 Cyst Removal 13:01 Capsule Contents 13:45 Irrigation 14:30 Sutures

This case evolved over 3-4 days. Patient was aware that an infection was present and had been put on an oral antibiotic to try to settle things down. Regrettably the infection worsened and clearly a pocket of purulent material formed. This has to be opened and drained at this stage or the infection simply won't clear. Local anesthetic may not always work when there is such localized infection but otherwise the procedure should be pretty straightforward. Hope everyone has a great day.

Ganglion cysts can be quite painful when they start compressing other structures. Surgeons used to be quicker to remove these but recurrence rates were high and many in my area don't offer this procedure anymore. If you simply drain them, the recurrence rates are very high. However, if you infuse steroid after draining them they tend to shrink and often times quite significantly.

This patient, like many others who develop lipomas, tends to get multiple ones and when they are painful we look to take them out. Most of them are fairly innocuous and unless they are pressing on something else or in an area where they present a cosmetic issue, I usually encourage people to leave them alone as you may develop scarring after the fact that is more bothersome than the original lipoma. This removal was straightforward and without complication. I actually removed the stitches for this procedure today and things were healing up nicely.

This was fairly straightforward. With cysts in general I always prefer to remove them intact unless they are so large that doing so would require a larger incision. This way, I am sure that the capsule is entirely removed. I have already seen this case in follow up and everything has healed nicely without any complicating issues. Have a great day!

The pathology report came back on this and did reveal that this was in fact a basal cell cancer. The metastatic potential for these is quite low and so long as they are removed efficiently and completely, they shouldn't recur. The best treatment for these is Mohs procedure where layer after layer is removed and analyzed until the pathologist confirms that everything is removed. Unfortunately, specialists and cancer centers in our area won't assess the patient until a tissue diagnosis is established so biopsies like this have to occur first.

This video is highly interesting to medical personnel as this condition is much more rare than typical cysts or lipomas. A kerion is essentially an abscess caused by a fungal infection and they are most common on the scalp. While you will run into them in industrialized nations from time to time, they are uncommon. I have only seen a handful in the last 20 years. However, in poorer nations these are much more common. I have been to Haiti a couple of times for disaster relief and both weeks that I spent down there I saw a few of these. At any rate, these are typically opened and drained and oral antifungals help these settle nicely. They are usually mistaken for bacterial infections and you'll here me debate this during the procedure but it is definitely fungal. I must apologize, however, as during the video I refer to this as a 'felon' accidentally, but what I meant to say was kerion. Anyway, have a great day!

In this video I drained 2 large blisters that developed secondary to frostbite. This is certainly common this time of year, especially here in Canada, but also applies to any large blisters that can develop secondary to burns or other irritations. The key with these is to drain them but then to retain the skin as long as possible as the tissues underneath will be quite raw. We drain them to avoid large tears. Anyway, there are a number of great wound products that we could mention here or in subsequent videos so I'll get into those as they are relevant. Have a great day!

The ultrasound report described this lesion as a lipoma but I should have known better. It didn't feel like one and as soon as I started to incise into it, my subconscious was screaming that this was a cyst....but sometimes that happens. At the end of the day it doesn't change much. In retrospect I would have done an elliptical incision as that would have made things a bit simpler but nothing is absolute. Approaches change as do outcomes, as you adjust to the situation you have. At any rate, this is my first post in quite some time. I'm looking forward to getting back into this. Take care!

Thank you all so much for your patience. It has been too long and I am now committed to redeveloping this channel and maximizing it as best I can. You have all been so helpful and I look forward to growing this together.

This is a very small procedure that can assist with the drainage of a stye or cyst involving the eyelid. You can certainly choose to use anaesthetics here, and I always give patients the choice, but local anaesthesia can sting quite a bit here and usually unroofing these is a relatively easy process and even when you compress the stye or cyst afterwards, which can be a bit uncomfortable, it is easier on the patient then injecting it with lidocaine of something similar. Each case is unique however, as is the patient input. At any rate, once unroofed, these tend to heal quite nicely.

This was the removal of an epidermal cyst that had been infected about a month earlier. For the time frames involved this came out remarkably intact. Typically these don't reform as nicely and are a bit messy. I apologize that the lighting isn't fantastic. I didn't appreciate that at the time of filming. During the procedure I used a scalpel to dissect around the cyst and you certainly could have achieved the same thing with scissors. The insertion of the dermal sutures were a bit challenging as the patient's skin was quite tough. There is certainly a difference here, patient to patient. Otherwise this procedure went relatively well. Feel free to comment as always.

This is just another lesson in patience as it applies to cyst removal. Epidermal cysts are harder to remove intact but this can still be achieved, at times, if the clinician progresses at an appropriate pace. There could certainly have been some debate as to the appropriate type of incision, linear versus elliptical, but at the end of the day, this linear incision worked out well. Special shout out to Dr. Matt, who assisted with this video, and has since moved on in his training. He will do well with these, solo, in the future. Feel free to leave a comment although I've been remiss in answering these of late.

This procedure is performed by the Resident, Dr. Matt, and overall he does a really good job. It is hard to be videotaped when you aren't use to that kind of thing. You could tell watching the procedure that adhesions along the superior margin of the cyst were limiting it's removal. Once that area was broken down, it popped out pretty easily. Sorry for the delay in posting these things again. I'll keep working on that.

Sorry for the long absence. I'm involved with a number of things and I simply haven't had the time. This was a fairly clean and complete removal of a pilar cyst. The only debate to be had with this case would focus around the need to remove redundant tissue at the end of the procedure as this cyst was fairly large and left somewhat of a loose 'pocket' behind. This is about right at the limit where I have that debate. Any larger and I would have been forced to remove tissue but this size, and certainly cysts smaller than this one, will usually heal well with time. Within 4-6 months the scalp tissue will be normal without any sagging, etc. Anyway, thanks again for tuning in and feel free to leave a question and I'll try and get to it if I can. Take care.

This is actually a challenging area to remove a cyst and not one that I'd recommend for beginners to this sort of thing. The base of the neck has a lot of redundant tissue and folds and the anatomy is such, that without general anaesthesia and a greater ability to manipulate the patient, that access becomes difficult. Add to this the hair line and baby hairs in particular and this becomes even more challenging. I also wish that lighting and picture quality was better for this video, as seeing what I was seeing becomes almost impossible. Suffice it to say that it was very evident that this cyst had a deeper component which is why, at one point I cut off the upper portion of what looks like almost a complete cyst being removed. In these cases, seeing tissue types and appreciating what is and isn't cyst capsule becomes important. Once this is achieved by the person doing the procedure, even if you take this out in 4 or 5 sections, you will be confident, on examining the final area, that there is no cyst material left to be removed. This healed nicely and without incident.

This took me a little while to get to the right plane so while the lesion felt very superficial, it isn't until around the 4 minute mark where I get down to the cyst capsule. Otherwise this progressed nicely and came out more or less intact. I continue to work on the camera work but this does leave something to be desired at times. Feel free to comment and I'll try to get to these if I can.

I misspeak at the beginning and state that I'm utilizing a # 11 blade when it's clearly a #15 blade. The lesson with this case was that the cyst, while feeling superficial like most others, was actually deeper and took a little while to get to the right plane. If you aren't trying to learn these procedures then you can simply fast forward to the 5 min mark and the extraction proceeds pretty uneventfully from there. Please feel free to comment. Hope everyone is well and had nice holidays.

This is a pretty straightforward drainage of an infected epidermal cyst. The nape of the neck is a difficult area to prep as small baby hairs abound. That being said, sometimes hair nets and the like can help but this was done in clinic and those simply weren't available. Please feel to comment.

Sorry for the delay in putting out this video. I've been a bit tired lately and remiss in my postings. At any rate, this was a pretty straightforward removal. The secret with this one, as with many, is to progress slowly and be sure of your planes and everything else takes care of itself. This healed nicely and without complication.

This was a fairly straightforward removal. While it may make for a better video if I squeeze all the keratin out once the capsule is compromised I tend to leave that area alone and dissect out the remaining capsule for a 'cleaner' overall removal. I don't know if it is me, the magnification or the camera person but there seems to be more subtle movement/shaking of the equipment when there otherwise shouldn't be. I'll keep an eye on this moving forward. As always, feel free to leave a question. I try to get to them if I can.

I apologize for the lighting in this video but this was shot in clinic and this is simply what I had to work with. Also, at the 5:38 point we had to chop the video a little as the expressed liquid surprised the nurse and I lost her for a few seconds...which sometimes happens. Otherwise, this healed nicely and did not require packing.

The real teaching point with this case, not unlike others, is to proceed slowly. These very superficial cysts can rupture quite easily and while that's not much of a complication, it sometimes makes things a bit easier in the long run. This healed nicely and without incident. Please feel free to leave comments and I'll get to them if I can.

This was an older cyst that had ruptured previously and unfortunately broke down along the weak point which was the punctum. In these cases, while I may extrude a little bit of the keratin, I generally try to leave the cyst itself alone and dissect along its walls in an effort to get around it and eventually under it. Once I am there, it is easy to continue dissecting through the hypodermis and 'scoop' the cyst out. This healed nicely and without incident. I'm still playing around with the video formats, to a certain degree, and am not sure whether viewers find the fastforwarding useful or not. Let me know if you are able. Take care.

Surprisingly, the discharge from this abscess was mostly serosanguinous as opposed to frank pus and that's possibly because he'd had extended antibiotics beforehand. When you are irrigating these types of lesions it is better to do it in a pulsatile fashion in an effort to dislodge more material as opposed to slowly pushing your sterile water or normal saline in continuously. This healed up nicely and without incident.