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15 March 2005
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The Vein Hook Successfully Used for Eradication ofSteatocystoma Multiplex
SEOK-JONG LEE, MD, YOON SEOK CHOE, MD, BYUNG CHUL PARK, MD, WOEN JU LEE, MD, AND
DO WON KIM, MD�
BACKGROUND Steatocystoma multiplex is characterized by the formation of the numerous cutaneouscysts in the exposed area leaving some cosmetic problems for the patients. Only surgical excisionhas been effective, and its several variations were done with limited success. Because thepatients usually have many cysts, excision of cysts was tedious for the doctors and left scars onthe patients.
METHOD Five patients agreeing to participate in this experiments were selected. The vein hookused for ambulatory phlebectomy was employed to eradicate the cysts. The skin was incised appro-ximately 2 to 3 mm in length. Then the mosquito forceps removed the cysts by gently squeezingor hooking the inner or outer cyst wall. By completely removing tissue around the cyst, recurrence wasable to be prevented.
RESULT It took approximately 1 minute to excise one cyst completely, it left no hypertrophic scarsexcept for transient postinflammatory hyperpigmentation, and it had no recurrences for 14 to 30 monthson five patients.
CONCLUSION The use of this instrument is very simple and time-saving, providing excellent successrate with favorable cosmetic results. It can be a good alternative for eradication of the cysts in steat-ocystma multiplex.
The authors have indicated no significant interest with commercial supporters.
Steatocystoma multiplex is a disorder clinically
characterized by numerous cutaneous cysts
with nonkeratinizing walls. The walls are lined
by thin epidermis and sebaceous glands within or
adjacent to the cyst walls histopathologically.
There is no known medical treatment for this
disease, and surgical excision is the only effective
treatment. Patients usually have so many cysts,
however, that it takes a long time for surgeons
to excise them all, which can leave hypertrophic
scars in spite of high success rate.
Numerous surgical procedures have been tried to
overcome these limitations; for example, 18-gauge
needle aspiration,1 3-mm punch excision,2 laser
therapy,3 cryotherapy,4 incision, and artery forceps
extraction5 have not been satisfactory considering
time consumed, scar formation, and more import-
antly, success rate.
We employed a vein hook used for ambulatory
phlebectomy for patients with varicose vein of the
lower extremities. Its tip is properly bent twice,
so after being inserted through the narrow incision
and twisted, it can hook the outer or inner
surface of the cyst or its capsule (Figure 1). When
the cyst is pulled, the hook easily separates the cyst
from the surrounding soft tissue. The procedure
with the vein hook was anticipated to decrease the
size of the incision, reducing the time needed for
removing cysts from surrounding soft tissues and
for the excision of the cysts. This also diminishes
the possibility of scars for good cosmetic results
to the patients.
& 2007 by the American Society for Dermatologic Surgery, Inc. � Published by Blackwell Publishing �ISSN: 1076-0512 � Dermatol Surg 2007;33:82–84 � DOI: 10.1111/j.1524-4725.2007.33013.x
8 2
�All authors are affiliated with the Department of Dermatology, Kyung Pook National University Hospital, Daegu,Korea
The practical technique is to mark each cyst with pen
and to inject 1:100,000 epinephrine-premixed lido-
caine under each cyst. By injecting under the cysts,
the cysts then are pushed up just under the epidermis
for easy separation from the surrounding tissue in
addition to patients’ comfort. Next, the skin is in-
cised about 2 to 3 mm using a No. 11 blade at a right
angle (Figure 2A), and the cysts are removed by vein
hook without puncture of the walls if possible (Fig-
ure 2B). In contrast, if the wall is punctured, the cyst
should be squeezed to cause the contents to come out
first. The hook then inserts to grasp either the inner
or the outer wall for the cyst and pulls it out gently.
When the cyst is exposed, the baby mosquito forceps
grasp the portion of the cyst and pull it out gently
(Figure 2C). Other grasps are frequently needed to
remove the complete lining of the cysts adhering to
the surrounding tissues (Figure 2D). The wounds are
cleaned with gauze soaked in alcohol, and then the
margins are approximated by steri-strips.
Five typical cases of steatocystoma multiplex are re-
ported, which were treated by the above-mentioned
simple surgical technique (Table 1). On these five
cases, our method proved successful. They had a mild
transient hyperpigmentation for about 2 to 4 weeks,
and all resulted in satisfactory cosmetic work. Two
were eager to remove the remainder of the cysts
(Figures 3A and 3B).
We expect ‘‘simple incision or puncture for hook-
ing out the cyst by phlebectomy hook’’ to be very
successful in steatocystoma multiplex patients. It is
possible to work by making small incisions,
Figure 1. The vein hook used for the removal of the cystsand tip of hook bent twice (inset).
Figure 2. The sequence: incision by No. 11 blade (A); inser-tion of vein hook through the incision (B); pulling thehooked cyst out (C); and complete removal of cyst and sur-rounding soft tissue with help of mosquito forceps (D).
3 3 : 1 : J A N U A RY 2 0 0 7 8 3
L E E E T A L
approximately 2 to 3 mm, to minimize the risk of
tissue injury, infection, the resultant hyperpigmen-
tation, scarring, and operation time. Accordingly,
this method might be the first line of treatment of the
steatocystoma multiplex instead of conventional
excisional surgery.
References
1. Sato K, Shibuya K, Taguchi H, et al. Aspiration therapy in stea-
tocystoma multiplex. Arch Dermatol 1993;129:35–7.
2. Takuro K, Kyoko K, Masayuki N, Tamotsu K. A case of steato-
cystoma multiplex with prominent cysts on the scalp treated suc-
cessfully using a simple surgical technique. J Dermatol
1995;22:438–40.
3. Krahenbuhl A, Eichmann A, Pfaltz M. CO2 laser therapy for
steatocystoma multiplex. Dermatologica 1991;183:294–6.
4. Notowicz A. Treatment of lesion of steatocystoma multiplex and
other epidermal cysts by cryosurgery. J Dermatol Surg Oncol
1980;6:98–9.
5. Keefe M, Leppard BJ, Royle G. Successful treatment of steatocysto-
ma multiplex by simple surgery. Br J Dermatol 1992;127:41–4.
Address correspondence and reprint requests to: Seok-jongLee, MD, Department of Dermatology, Kynugpook NationalUniversity Hospital, 50, Samduck-2-ga, Chung-gu, Daegu,Korea (South) 700-721, or e-mail: [email protected].
TABLE 1. Vein Hook Operation 5 Cases
No. Sex
Age
(years) Location
Duration
(years)
Size
(mm) Number
Follow-up
(months)
Side
effect Recurrence
1 Male 53 Neck 30 5–10 12 22 (–) (–)
2 Male 28 Arm 12 3–5 14 15 (–) (–)
3 Male 24 Forearm 10 4–6 11 30 (–) (–)
4 Female 31 Neck 6 5–7 8 19 (–) (–)
5 Male 46 Face 20 7–10 5 14 (–) (–)
Figure 3. Preoperative feature (A) and 4 weeks post-operative feature (B) in Case 1.
D E R M AT O L O G I C S U R G E RY8 4
V E I N H O O K F O R T H E E R A D I C AT I O N O F S T E AT O C Y S T O M A M U LT I P L E X