hey welcome for joining us I'm here with
my friend John he's been a patient for
10 years probably
and we're going to do a cyst on his back
it has been there for years years and
what happens with it was fills up with a
way to gooey substance that does not
spell appealing and it's time to get it
removed
ok then you had stuff come out of it
lately right oh yes
yeah okay so we're going to get this
taken out it's probably epidermoid
sister feels like one and by outlining
the margin where you can feel the raised
part of it we can get an idea of how
large it is at least how large the skin
around it is and take it out probably
with an elliptical excision that would
work best
many of our viewers have probably seen
dr. pimple popper do simple similar
procedure oftentimes she's a punch
biopsy first and then the sect around
the system
we're just going to go in with
analytical excision on this case first
and Jack where it's going to be feel
that John sorry you're always so easy
going
you do feel it all right oh yeah okay
one of the things I'm not thrilled about
with this going into it is that it's had
a lot of trauma to it with the squeezing
and the healing and the squeezing and
the healing and so that it's going to be
kind of tough with some scar like tissue
might make a hard to get a nice neat
removal of a sack on one piece the sack
may actually be ruptured at the moment
when I was feeling it before we got
started i was able to feel the edge of
it you can't do that once the anesthetic
has filled all of the superficial tissue
it's all hard and for so you just kind
of have to go by your your landmarks
which is the the drawing with a pen
I'm going to make a vertically oriented
ellipse and then we're going to going to
the sect assist out once we do this
that's one side of the lips
this is the other side of the lips so
now I'm going to sort of trace what we
just did but what's nice is the blade
likes to go in we're already cut so it's
not like a totally blind and I can kind
of feel that a minute and the reason I'm
not just aggressively going to hit and
going in is because there's there's a
cyst that will rupture inside of there
and I don't want to rupture if I can
help it
you'll see different techniques watching
the different channels and you're just
watching one channel you'll see
different techniques one of the things
that you're noticing is how thick the
skin of John's back is not terribly
unusual for a back to have skin it's
really thick it's not the john cystic
skin
so please do comments they add comments
if you have comments about to John's
experience here for similar experiences
you've had my let's look down here and
i'll see that right there think I want
to set around that we're just finishing
getting through the skin here you can
see how that's I don't know if you see
yellowish fat it's actually about the
same color as the skin but then we come
around this side we have this white
structure below the skin right there
kind of roundish looking i don't want to
use a sharp knife right on that I want
to use well scissors are short two but
scissors if you go in and separate like
that can do what we call blunt this
section separate as dr. tan used to say
just freed up around it
but being careful not to rupture the
cyst because i think it's there's lots
of videos of them where the doctor
ruptures assistance squeeze it all out
because there's a lot of people who love
seeing that stuff come out that you know
after all it's dr. pimple popper there's
something satisfying about seeing all
that come out i think there's something
satisfying about taking it out on one
piece i forgot don't find ok they're
they're both interesting
being also careful and if you happen to
be a physician who does this procedure
please comment we would love to hear
words of wisdom you have to share with
us
okay look at that totally entertaining
other people we will get comments that
they don't come off now saying oh please
why didn't you when you open it why
don't you get all the contents out like
that because i want to give it to the
pathologist just like that I want them
to have the whole thing to look at that
that is beautiful now the reason I'm not
put a suture in the twelve o'clock
location on this one is because we're
not concerned about a cancer and whether
it's still left behind we're just we're
just sending them off assists
2-centimeter maybe 1.1 take a big bite
of the deep part they're starting from
lower and coming out higher and then
going to the opposite side and starting
higher and coming out lower see what i'm
doing here
ok so what I'm doing is making it so the
knot is going to be the bottom and this
pulls the deeper tissues together to
take some of the tension off of the skin
there we go good all right there
it's holding now job and then you cut it
just above the knot
the more comfortable never change do out
to make you telling the CL Moore
together
oh you're a genius John it worked
don't move you'll notice because of how
tough the Skip wasn't actually bent the
needle it normally is a different curve
that's a more currencies straightened it
out
straightening the curves what's what's
what's the song would help my tony was
from its television program would it
help if I told you what the visual
wasn't went with that line of the song
if I get the character in way it gives
away or the name of style of shorts is
that from you that happened it was Hank
Williams jr. wasn't it
it's not you're going to hear about it
no comment below
look at this let's get dr. look at this
all that trouble to come up with a
beautiful vertical linear scar there's a
song about that too
jim morrison's grave by Steve Taylor
ok five and my sense of aesthetics is
killing me to not have one located here
is that bothering anybody else have one
there
yes but it's not necessary for it to
heat it's just so we will have input
beautiful dressing on that just
beautiful totally intact the pathologist
will take it a person and tell us what
it is
John did you see it no oh you guys see
it
that's what that has been squirting out
yet
yeah there's a lot of tension there
still we do want you to not be doing
things really pulling with your arms
that will pull on this a lot over the
next 10 days while we're leaving the
sutures in and now that you're on this
side of it you've experienced it with
what words do you have for people who
might be going under a similar procedure
not a problem a lot larger than i
expected haha
sometimes they are yeah but we got it up
we have John came back because he thinks
he may have broken a stitch from the
procedure that we did let's check and
see it looks good from the outside
did you feel something or was a pain
well where did he change the bandages
for is you know where there were six
stitches is only through the holes are
but the stitch wasn't in the band it's
our nature didn't suck inside
you feel it mmm i pulling that's the the
vertical mattress the knot is to the
side so it's intact
oh it's just where where the incident is
that's where the suture goes under and
across the back out close this up and
then I'll draw a little diagram showing
exactly if this is the wound the skin
above it the way that suture works is we
go in and we take a bite and we come out
and then instead of tying across here go
back in take a bigger bite and then type
over here on the side so that not is off
to the side and it allows us to get a
lot more surface area that the sutures
pulling on because we had all that
tension so actually you know your
concern but I'm really happy without
life
excellent yeah so you're not heard no
okay so this is the day after we did it
right correct post-op day 12 and well
hey thanks for watching guys even got to
see a little bit of follow up there with
the day after so John's doing great and
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