๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Alternative approaches
Alternative approaches
Direct puncture with an 18G needle may be used in small lesions that have relatively nonviscous contents, given the relatively large bore size of the 18G needle. Contents of a digital mucous cyst or trapped blood coagulum can be adequately drained when the tip
of the 18G needle is kept inside the target space and pushed laterally away from the wound access point in order to open and enlarge the defect. The resulting rounded opening generally permits spontaneous drainage of the exudate. Care should be taken not to remove the needle immediately after puncture so that the nascent skin access point does not reclose. Patience is required with this approach, as it may require 1 to 2 minutes to see the viscous contents slowly drain out while the tip of the needle is kept in place. Importantly, the contents will not rapidly and spontaneously drain. A cottontipped applicator is useful to push the lateral wall of lesion outward immediately after the needle is removed to facilitate complete drainage. I&D of digital mucous cysts may be followed by other treatments such as cryotherapy or injection of sclerosing solution or triamcinolone.3,4
Direct puncture with an 18G needle connected to a syringe followed by negative pressure application by withdrawing the syringe plunger can be used to drain the exudate associated with dissecting cellulitis or trapped blood coagulum of larger veins. The use of duplex ultrasound guidance is particularly helpful in avoiding local arterial injury.
Performing the incision with a punch instrument can be useful because it gives a round-shaped opening for drainage instead of a linear slit. Due to the round-shaped opening, exudate continues to drain at home after the performance of in-office I&D, which may minimize the need to insert wound-packing material. Punch incision is particularly useful in draining thick exudate such as noninflamed epidermal inclusion cysts, as releasing the keratinous content alleviates discomfort from built-up pressure.5 The size of the punch instrument should be commensurate with the size of lesion and the thickness of exudate. However, the greater ease of drainage associated with utilizing a larger-sized punch instrument should be weighed against the risk of a more substantial postoperative scar. In general, a punch instrument size of 4 mm or less should produce acceptable scar cosmesis.6