“…7 The pathogenesis of auricular pseudocysts is not clear, but there are two main hypotheses. 2,8 First, chronic low-grade trauma induces the release of lysosomal enzymes, which results in cartilage degeneration. Second, congenital embryologic dysplasia of the auricular cartilage results in residual tissue planes within the cartilage and then reopens and forms an auricular pseudocyst.…”
The authors have indicated no significant interest with commercial supporters.S everal treatment modalities for auricular pseudocysts, such as incision and drainage with or without compression (e.g., suture, prosthesis), intralesional or systemic steroid administration, intralesional sclerosing agent injection (e.g., minocycline, fibrin glue, iodide, trichloracetic acid), and surgical intervention, are described in the literature. 1-6 These methods can achieve reasonable results with few recurrences, but complications still occur, and some of them are too invasive or difficult to be performed at office-based clinics.We present a clip compression dressing method for the treatment of recurrent auricular pseudocysts that can be performed readily at office-based clinics.
Surgical TechniqueA 26-year-old Korean man with a history of atopic dermatitis presented with recurrent episodes of a left auricular pseudocyst. We aspirated 1 mL of strawcolored fluid with a 27-gauge insulin syringe and injected 0.5 mL of 5-mg/mL triamcinolone acetonide solution. Then we estimated the location of clips, covered the ear with gauze, and fixed it using three U-shaped, bent clips along the indentation of the ear to compress the triangular and scaphoid fossa. Several pieces of tape were applied for adherence to the skin (Figures 1, 2). The gauze was kept on the lesion for a day and then removed to ensure that no pressure necrosis developed. From then on, we changed the gauze every 2 days to keep the lesion clean and removed it on day 7. At the 6-month follow-up, there was no evidence of recurrence, and the cosmetic outcome was excellent ( Figure 3).
“…7 The pathogenesis of auricular pseudocysts is not clear, but there are two main hypotheses. 2,8 First, chronic low-grade trauma induces the release of lysosomal enzymes, which results in cartilage degeneration. Second, congenital embryologic dysplasia of the auricular cartilage results in residual tissue planes within the cartilage and then reopens and forms an auricular pseudocyst.…”
The authors have indicated no significant interest with commercial supporters.S everal treatment modalities for auricular pseudocysts, such as incision and drainage with or without compression (e.g., suture, prosthesis), intralesional or systemic steroid administration, intralesional sclerosing agent injection (e.g., minocycline, fibrin glue, iodide, trichloracetic acid), and surgical intervention, are described in the literature. 1-6 These methods can achieve reasonable results with few recurrences, but complications still occur, and some of them are too invasive or difficult to be performed at office-based clinics.We present a clip compression dressing method for the treatment of recurrent auricular pseudocysts that can be performed readily at office-based clinics.
Surgical TechniqueA 26-year-old Korean man with a history of atopic dermatitis presented with recurrent episodes of a left auricular pseudocyst. We aspirated 1 mL of strawcolored fluid with a 27-gauge insulin syringe and injected 0.5 mL of 5-mg/mL triamcinolone acetonide solution. Then we estimated the location of clips, covered the ear with gauze, and fixed it using three U-shaped, bent clips along the indentation of the ear to compress the triangular and scaphoid fossa. Several pieces of tape were applied for adherence to the skin (Figures 1, 2). The gauze was kept on the lesion for a day and then removed to ensure that no pressure necrosis developed. From then on, we changed the gauze every 2 days to keep the lesion clean and removed it on day 7. At the 6-month follow-up, there was no evidence of recurrence, and the cosmetic outcome was excellent ( Figure 3).
Punch instrument is a circular blade that can be used for many diagnostic and therapeutic purposes in different medical and surgical specialties. Punch surgery (or biopsy) is achieved by using this versatile punch blade under local anesthesia. Basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal. Diagnostic punch surgery can obtain a part of or whole skin lesion for histologic examination. In addition to the skin, nail and mucous membrane tissue can be obtained by punch biopsy. Interestingly, punch biopsy can be used as an adjunctive to fine-needle aspiration to establish the diagnosis of tumors of solid organ such as the breast. Diagnostic punch surgery can be modified to overcome certain problems. The split-punch technique helps avoid crushing the tissue punch when trying to divide it for different examinations. The double-trephine punch facilitates obtaining subcutaneous tissue without the need for full elliptical excision. The string-of-beads technique obviates the need for dissection of tissue into pieces. In other nondermatology and dermatology conditions, such as nerve pathology, arteriosclerosis, melanoma mapping, and eyelid tumors, the diagnosis can be enhanced with the use of punch surgery.Therapeutic punch surgery can be used for excision of unwanted lesions such as nevi, as well as pathologic bone and cartilage tissues. Punch grafting is used in vitiligo surgery and hair transplantion. Punch evacuative surgery can help in the evacuation of unwanted tissue or materials such as lipoma, subungual hematoma, scrotal calcinosis, pseudocyst of the auricle, pilar cyst, and others.Reconstructive punch surgery includes correction of ear lobe defects and acne scars. Enhancement of wound healing can be achieved by use of the punch; therefore, it can help nonhealing ulcers.
“…Punch holes (2 or 2.5 mm) are made in the floor of the granulating ulcer 5 mm from each other, and grafts are pushed into these recipient holes. [ 13 ] Punch can be used for extrusion of epidermal inclusion cyst, hidrocystomas, pilar sheath cyst, and pseudocyst of auricle[ 14 ] with a punch hole technique and the contents of cyst are drained and pressure bandage is applied [ Figure 5 ]. Figure 5 Epidermal inclusion cyst extrusion The punch and graft technique in chondrodermatitis nodularis helicis: A punch biopsy is applied perpendicular to the skin surface and advanced until a deep punch of underlying cartilage is cut.…”
Section: Introductionmentioning
confidence: 99%
“…Punch can be used for extrusion of epidermal inclusion cyst, hidrocystomas, pilar sheath cyst, and pseudocyst of auricle[ 14 ] with a punch hole technique and the contents of cyst are drained and pressure bandage is applied [ Figure 5 ].…”
The skin punch or surgical punch is an instrument which is used almost exclusively by dermatologists. It is a circular hollow blade attached to a pencil-like handle ranging in size from 0.5 to 10 mm. It is available as a disposable, reusable, and automated instrument. The punch can be used as a diagnostic, therapeutic, and cosmetic tool in dermatology. We have used punch as a diagnostic, therapeutic, and cosmetic tool in our dermatosurgery practice in our hospital. Various original research articles, text book publications, and review articles were studied and compiled. Techniques used by various authors and our own experiences with punch have been described. This article aims at providing the novel usefulness of skin biopsy punch in dermatology as the basic punch surgery is quick and easy to learn. Complications such as bleeding and infection are minimal.
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