Tags: lipoma treatment in Bhopal , lipoma removal in Bhopal, lipoma cure in Bhopal, lipoma in neck in Bhopal, lipoma excision, lipoma removal cost in Bhopal, lipoma on back, lipoma surgery cost, lipoma in armpit in Bhopal, lipoma on forehead, lipoma stomach, lipoma doctor in Bhopal, lipoma removal surgery in Bhopal, lipoma on shoulder

Introduction

A lipoma is a soft, benign, slow-growing subcutaneous tumor lesion, formed from a proliferation of adipose cells originating from fatty tissue and encapsulated by fibrous or non-fibrous tissue, well defined, of variable size (from a small nodule subcutaneous to an important mass that deforms the anatomical region), single or multiple, mobile and that is not usually attached to the skin or deep planes.

They affect 1% of the population, more frequently men between 40 and 60 years of age, being very rare in children.

Although they are easy to diagnose, simply by inspection and palpation, we must bear in mind that not all soft subcutaneous masses are lipomas.

Lipomas are clinically perceived as subcutaneous masses, asymptomatic, symmetrical, slow growing (and can reach a large size), soft palpation and elastic, pasty or cystic consistency, regular and rounded to ovoid or discoid, but with borderline imprecise, and the surface is septets or lobed to the touch.

The most common locations are the shoulders, the base of the neck, the back, the upper and lower extremities, and the nape region.

It should be differentiated from epidermal cysts (wrongly called sebaceous), since their surgical approach is different. The cyst is made up of keratin and surrounded by a more or less hard capsule, complete removal of this capsule being essential to avoid recurrences. This topic was dealt with in an article in a previous issue of the magazine and therefore it has not been commented on in this monograph.

Indications

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.

Indications

• Large lipomas or those located in supportive areas can cause discomfort that indicates their removal.
• Restriction of movement. Lipomas located in areas that affect the movement of a joint.
• Rapid growth or change in appearance Any lesion that shows one or both of these characteristics should be excised. The actual characteristics of a "lump" are not known until it is studied anatomopathologically.

Contraindications for removal

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:

• Lipomas located in the armpit, groin, supraclavicular fossa, and popliteal fossa may be close to important neurovascular structures and their treatment should be avoided in Primary Care.
• Lipomas located on the nape can be difficult to remove due to the large size that they usually acquire before giving symptoms and their immediately supramuscular situation.
• Atypical locations (such as the scalp, fingers, hands, feet, etc.) should call into question the lipoma diagnosis and, if they require treatment, the patient should be referred.
• When the lipoma is located on the trunk, it is important to discern whether it is in the subcutaneous plane or in the submuscular plane, in which case we must refrain from considering treatment in the health center.

Necessary material

• Povidone iodine or chlorhexidine solution.
• Surgical pen or marker.
• Syringes (1, 2 and 5 cc) and needles (21G, 25G or 30G).
• Sterile gauze.
• Sterile gloves.
• Fenestrated and non-fenestrated sterile drape.
• Scalpel blade no. ^or
• Scalpel Handle No. ^or
• Electric scalpel terminal.
• Hemostatic forceps (Kelly or Pean).
• Mosquito forceps (Halsted), curved and straight.
• Allis forceps.
• Dissecting forceps with and without teeth, Adson type.
• Metzenbaum scissors, fine, curved and with blunt tips.
• Cutting scissors (Mayo).
• Small needle holder (best with tungsten carbide branches).
• Separators, erines or hooks.
• Silk suture of the appropriate number (2/0, 3/0, 4/0 and 5/0).
• Resorbable suture (Safil ^®, Vicryl ^® ), of the appropriate number (4/0 and 5/0), if necessary.
• Tape or self-adhesive dressings.
• 10% formalin, in a plastic container.

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.

Technique

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.

• We delimit the lipoma by palpation and paint the edges with ink. We mark the incision line with a surgical pen (always parallel to the tension lines)

• Once washed and gloved, we apply chlorhexidine (or povidone) extensively to clean and disinfect the area. It is essential to be rigorous with asepsis, antisepsis and disinfection.

• We apply the local anesthetic on a sheet, covering all the tissue to be dissected, according to the perilesional infiltration technique.

• The incision is made linearly with the scalpel in the skin to the subcutaneous cellular tissue, tightening the skin, until reaching the lesion, detaching the surface area.

 Treatment

Treatment for lipoma is not usually necessary. However, if the lipoma is uncomfortable, painful, or grows, your doctor may recommend that it be removed. Lipoma treatments include the following:

• Surgical extraction. Most lipomas are removed surgically by cutting. Reappearance after removal is rare. Side effects that can occur are scarring and bruising. The scar can be diminished with a technique known as minimal incision extraction.
• Liposuction This treatment uses a needle and a large syringe to remove the fat lump.

What to expect from your doctor

Also, your doctor is likely to ask you questions, such as:

• When did you notice the bump?
• Has it grown?
• Have you had similar growths in the past?
• Is the lump painful?
• Have other people in your family had similar bumps?

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.

Care

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.