Melissa writes with some interesting questions: “My 3 year old Siberian Husky has a sebaceous cyst (diagnosed by 2 different veterinarians). It started off a pea size, about 6 months ago and grew to an inch wide, by an inch and a half tall. It burst a week ago (what a mess!). Now it is an open hole and I can see the large cyst inside of it. He goes in for surgery on Monday, and I’m wondering if he will need an Elizabethan collar (cone) (it’s on his head in the middle, just behind his ears). It is itchy as heck, and we’ve trained him not to scratch it. Does he need an E-collar? If so, how long until it can come off so he can sleep, eat, and drink? How long does it normally take until 6 stitches can come out?”
Melissa, I’m most concerned about the diagnosis. I’ve never seen a sebaceous cyst that huge. I believe the largest one I’ve seen (in 30 years of practice) might have been the size of an English pea. Keep in mind that not all cysts are sebaceous cysts, and some cysts may be cancerous. Be sure to have your veterinarian send the tissues in to a pathologist to have histopathology performed on it.
Let’s also stop and define “cyst.” It’s a word that gets thrown around a lot and its exact meaning is “any closed cavity or sac, normal or abnormal, lined by epithelium and especially one that contains a liquid or semisolid material.” (Definition courtesy of Dorland’s Illustrated Medical Dictionary.) A lot of structures that get called cysts actually aren’t.
Whether a patient needs an Elizabethan collar depends on his likelihood to scratch, rub or otherwise disturb the surgery site.
Melissa tells us that this mass is “itchy as heck,” which means he is very likely to be working on it, especially when no one is looking. An Elizabethan collar beat a resuturing any day.
Surprisingly, most dogs can eat, sleep, drink, use the bathroom, do everything they need to do with the E-collar on. While it’s OK to remove it temporarily when you are watching the pet, any time he is not monitored it needs to go back on.
When sutures come out is also variable, as the location on the body, speed of healing, age, and many other factors may be involved. That this dog’s lesion is on top of his head, where skin is very thick and heals slowly, is an indicator that the sutures may need to stay in for 14-21 days. Again, leaving sutures in sure beats a resuturing. I have seen a few times when sutures were removed too soon and the surgical incision had to be closed again.
Happy Thanksgiving and we will see you tomorrow, Dr. Randolph.