EXCISION OF LIPOMA

EXCISION OF LIPOMA

PREOPERATIVE DIAGNOSIS:  Lipoma.

POSTOPERATIVE DIAGNOSIS:  Lipoma.

PROCEDURE PERFORMED:  Excision of lipoma.

ANESTHESIA:  Local anesthesia.

COMPLICATIONS:  None.

INDICATIONS:  I recommended to the patient to undergo the above-named procedure.  Procedure, purpose, risks, expected benefits, potential complications, alternatives forms of therapy were discussed with the patient, and the patient was agreeable to surgery.

DESCRIPTION OF PROCEDURE:  The patient was identified and an informed consent was obtained.  A marking pen was used to draw an outline of the lipoma and a planned skin excision on the skin surface.  The outline of the tumor helped to delineate margins, which was obscured after administration of the anesthetic.  Excision of some skin helped to eliminate redundancy at closure.  The skin was then cleansed with povidone iodine/chlorhexidine solution, making sure to avoid wiping away the skin markings.  The area was draped with sterile towels.  Local anesthesia was administered with 1/2 percent lidocaine with epinephrine, as a field block.  A 3-mm to 4-mm incision was made over the lipoma.  The incisions were configured like a fusiform excision following the skin tension lines and were smaller than the underlying tumor.  The central island of skin to be excised was grasped with a hemostat/Allis clamp, which was used to provide traction for the removal of the tumor.  Dissection was then performed beneath the subcutaneous fat to the tumor.  Tissue cutting was performed under direct visualization using a #15 scalpel/scissors around the lipoma.  Care was taken to avoid nerves/blood vessels that may lie just beneath the tumor.  Once a portion of lipoma has been dissected from the surrounding tissue, hemostats/clamps were attached to the tumor to provide traction for removal of the remainder of the growth.  Once it was freed, the lipoma was delivered as a whole.  The surrounding tissue in the hole was palpated to ensure complete removal of the tumor.  Adequate hemostasis was achieved following the removal of the lipoma using hemostats/suture ligation.  The dead space was closed beneath the skin using buried, interrupted 3-0/4-0 Vicryl sutures.  Occasionally drains have been placed to prevent fluid accumulation.  The skin was then closed with interrupted 4-0/5-0 nylon sutures.  A pressure dressing was placed to reduce the incidence of hematoma formation.  The patient is given routine wound care instructions, and the wound is checked in two to seven days.  The sutures are removed after seven to 21 days, depending on the body location.  Specimens were submitted for histologic analysis.