Minor Surgery

Services provided

Procedures in the categories below and other procedures, which the Ailesbury Clinic deems competent to carry out, will be covered by this patient directed service. These procedures have been classified into the following main groupings:

  • Injections/Aspiration/Arthrocentesis(muscles, tendons and joints). Includes cortisone and hyalgan injections..
  • Invasive procedures, including r/o all skin cancers, pigmented nevi, ganglions, sebaceous cysts, lipomas, dermatofibromas, abscesses or tumours.
  • Treatment of verrucae or plantar warts with cryotherapy CO2 laser/Erbium YAG laser and Aldara cream
  • Suturing and repair of superficial and deep wounds.
  • Skin Biopsy of subcutaneous lesions or rashes for histopathological diagnosis
  • Treatment of Actinic Keratosis by PDT/ALA, cyrotherapy and CO2 laser
  • Treatment of superficial BCC by Photodynamic Therapy ALA and 633nm Omnilux

Nursing support

Registered surgical nurses are present to provide support and care to patients undergoing minor surgery. Nurses assisting in minor surgery procedures usually are also trained in laser therapy and competent to assist in minor procedures.

Sterilisation and infection

Although it is recognized that minor surgery performed in General Practice has a low incidence of complications, it is important that practices providing minor surgery operate to the highest possible standards. The Ailesbury Clinic uses approved Excel autoclaves and sterilization procedures that comply with national guidelines.

Consent

In each case the patient is fully informed of the treatment options and the treatment proposed. The patient gives written consent for the procedure to be carried out and the completed consent form should be filed in the patient’s medical record.

Pathology

All tissue removed by the Ailesbury Clinic are sent routinely for histological examination to St. Vincent’s Hospital and are usually seen by a dedicated skin histopathologist Dr. Keiran Sheehan. It is considered acceptable not to overload the service with diagnostically obvious lesions such as sebaceous cysts etc.

Audit

Full records of all procedures should be maintained in such a way that aggregated data and details of individual patients are readily accessible. The Ailesbury Clinic regularly audits peer-review minor surgery and cosmetic work.

Continual patient care

There is an opportunity for the referral General Practitioner to be part of their own patient’s continuing care by electing to remove sutures etc. or by monitoring a patient’s progress.

Pricing

There is a €150 consultation fee and treatments will be priced in accordance with the approved Insurance Provider schedule of benefits. Medical card patients will have the facility to sign a STC if their doctor provides a proper referral form. Obviously this has to be within reason and patients presenting with multiple sebaceous cysts or multiple seborrheoic keratoses may incur a higher fee depending on the complexity of the procedure.

Ganglion cyst

  • A ganglion cyst most often involves scapholunate joint of dorsal wrist.
  • These arise in young to middle-aged adults.
  • They are 3 times more common in women than in men.
  • The cyst is a unilocular of multilocular firm swelling 2–4 cm in diameter that transilluminates.
  • Cyst contents are mainly hyaluronic acid, a golden-coloured goo.

Mucous/myxoid pseudocysts

  • Mucous/myxoid pseudocysts arise in older adults on distal phalanx
  • They arise from distal interphalangeal joint, associated with osteoarthritis.
  • They often present as a longitudinal depression in the nail due to compression on the proximal matrix.

Labial mucous/myxoid cyst

  • A cyst in the lip may be due to occlusion of the salivary duct
  • They are also called mucocoele.
  • It is a soft to firm firm, 5–15 mm diameter, semi-translucent nodule.

Hidrocystoma

  • Hidrocystoma is a translucent jelly-like cyst arising on an eyelid.
  • It is also known as cystadenoma, Moll gland cyst, and sudoriferous cyst.
  • The common solitary translucent eyelid cyst is an apocrine hidrocystoma.
  • Multiple cysts on the lower eyelid are eccrine hidrocystomas

Milium/milia

  • Milia are 1–2 mm superficial white dome-shaped papules containing keratin
  • Primary milia arise in neonates (50%), adolescents and adults; they are rarely familial and sometimes eruptive.
  • Primary milia occur on eyelids, cheeks, nose, mucosa (Epstein pearls) and palate
    (Bohn nodules) in babies; and eyelids, cheeks and nose of older children and adults.
  • ransverse primary milia are sometimes noted across nasal groove or around areola.
  • In milia en plaque, multiple milia arise on an erythematous plaque on face, chin or ears.
  • Secondary milia arise at the site of epidermal repair after blistering or injury, eg epidermolysis bullosa, bullous pemphigoid, porphyria cutanea tarda, thermal burn, dermabrasion.
  • Secondary milia are reported as an adverse effect of topical steroids, 5-fluorouracil cream, vemurafenib and dovitinib.

Trichilemmal cyst

  • 90% of trichilemmal cysts occur on scalp; otherwise face, neck, trunk, and extremities.
  • Most trichilemmal cysts arise in middle age.
  • In 70% of cases, trichilemmal cysts are multiple.
  • They presents as adherent, round or oval, firm nodules.
  • There is no punctum.
  • The keratinous content is firm, white and easily enucleated.

A trichilemmal cyst is also called pilar cyst.

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