Lipoma is a medical condition in which a mass of fat develops in between the skin and the underlying tissue layer. It is mostly observed in middle aged people. The identification of a lipoma is pretty easy. It is a fatty lump which moves when touched with a finger. These are generally harmless but some do hurt or pain on touching. Under these circumstances one must get a lipoma removed.
The presence of a lipoma in one’s body can be detected by some common symptoms. These include a lump of fat which is doughy to the touch. This lump is generally 5 cm in diameter and one must also keep in mind that a lipoma grows too. Since, they consist of many blood vessels, they can sometimes be painful too. Lipomas generally occur in the neck, shoulder, back, abdomen, arms and thighs.
The cost of Lipoma Removal Surgery depends on Surgeon’s Qualification, Operative facilities, Technique of liposuction, Number of Lipoma's, Size and location of the Lipoma, Stay Required or not, Anaesthetist Experience, Type of Compression garment & Post care facilities given to the patient.
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In general, surgical treatment of lipomas is not recommended unless adjacent structures are compressed or there are diagnostic doubts. The therapeutic attitude must be expectant in cases of small lipomas that do not cause functional alteration, although their evolution should be followed, assessing their size; if it is large, complete surgical excision and subsequent pathological study will be indicated.
The only curative treatment for lipoma is surgical excision of the tumor, whatever its location and size. The goal is careful removal of the entire tumor to minimize complications.
Relative
Infection. It does not contraindicate removal, but it is preferable to defer it and address it after the appropriate antibiotic treatment, with greater aesthetic guarantees and less probability of recurrence.
Abcessification. Neither does it contraindicate removal, the prior step of surgical drainage being required and after the abscess has healed, removal of the lipoma will be indicated.
Absolute
Big size. Large lipomas (larger than 4 or 5 cm) and giant lipomas should be removed in a hospital setting.
Location. Avoid removal of lipomas located in risk areas:
It is very important to have adequate instruments and in sufficient quantity. You always have to take into account the unforeseen or complications that may arise at any time.
Small lipomas can be removed by enucleation or simple excision, and larger ones by fusiform excision, dissecting the surrounding tissue.
In this case, we are going to describe simple excision, which we consider to be the technique of choice in the removal of lipomas.
Preparation of the surgical field
If we are in a hairy area, we will consider cutting the hair.
Also, your doctor is likely to ask you questions, such as:
We catch the lipoma with the Allis forceps or the mosquito or with several mosquitoes, we pull at the same time that we compress from the sides of the wound and we take off the different planes with the scissors, the mosquito or the finger and, helped by the separators, we obtain a good direct view of the surgical field . As adhesions to the subcutaneous cellular tissue are minimal, dissection or "peeling" is usually easy to perform.
We will try to extract the specimen en bloc, after palpation of the adjacent tissues , to ensure complete removal of the tumor.
We will perform hemostasis of the different blood vessels in the surgical area. Haemostasis of the residual dead space must be complete to avoid a hematoma or seroma, using digital compression, hemostats, electrocoagulation, or ligation points. Subsequently, the suture is made by planes, closing with 2 or 3 subcutaneous resorbable stitches 3 or 4, giving inverted stitches with a buried knot, thus avoiding virtual spaces and leaving drains if necessary, although in most cases Sometimes simple excision is sufficient with simple discontinuous points closing the skin without the need to close the deep planes.
As the edges of the surgical wound are already dissected, no previous preparation of the skin is necessary for its closure, however, the degree of resistance to closure of the wound must be assessed, to avoid ischemia of the edges; if necessary, we will perform a greater blunt subcutaneous dissection of the entire wound margin, with dissection scissors or mosquito, using hooks or Adson forceps with teeth.
The closure of the skin is done with simple discontinuous stitches. The epidermis is closed with a non-absorbable suture (nylon or silk). It is important to achieve eversion of the edges of the surgical wound, the basic principle of closure of the skin with sutures. The number of stitches will depend on the tension of the wound, the thickness of the thread and the type of closure.
Indicate analgesia, if there is pain or, better, anticipating the possibility of it.
We indicate aftercare and the next check-up appointment. The patient must be advised of the postoperative risks and self-care of the surgical wound.
We record the procedure in the health history and fill in the postoperative sheet.
The surgical wound will be checked at 24-48 hours, with usual care, and the patient will be summoned for the subsequent removal of the stitches (7-21 days, depending on the area). Post-adhesive suture placement may be considered for a few days to avoid the risk of wound dehiscence.
We recommend an appointment for a review 5 weeks after excision, with postoperative control to rule out or resolve minor discomforts, such as pain in the incision area (which increases with physical exertion, does not radiate and usually subsides with rest and with non-steroidal anti-inflammatory drugs) or, sporadically, local burning and a sensation of local heat, which usually subside with corticosteroid creams.