Lipoma

Surgical Technique

What is the process of removing a lipoma?

• First, Dr.Mountcastle palpates and examines the lipoma to make sure it is located above the muscle. He will sometimes ultrasound the lipoma to confirm this but most often, a true lipoma is located above the muscle making it very easy to surgically remove in the office. The skin is then cleansed with povidone iodine (Betadine) or chlorhexidine (Betasept) solution. The area is draped with a sterile fenestrated drape. Local anesthesia is administered with 1 or 2 percent lidocaine with epinephrine; infiltrating the anesthetic in the subcutaneous area surrounding the operative field.

• The incisions are configured like a fusiform excision following the skin tension lines and are smaller than the underlying tumor. The central island of skin to be excised is grasped with a hemostat, or Allis clamp, which is used to provide traction for the removal of the tumor. Dissection is then performed beneath the subcutaneous fat to the tumor. Any tissue cutting is performed under direct visualization using a no. 15 scalpel or scissors around the lipoma. Care must be taken to avoid nerves or blood vessels that may lie just beneath the tumor.

• Once a portion of lipoma has been dissected from the surrounding tissue, hemostats or clamps can be attached to the tumor to provide traction for removal of the remainder of the growth. Once it is freed, the lipoma is delivered as a whole. The surrounding tissue in the hole can be palpated to ensure complete removal of the tumor. The dead space is closed beneath the skin using deep, absorbable sutures. The skin is then closed with superficial, interrupted sutures. A pressure dressing is placed to reduce the incidence of hematoma formation. The patient is given routine wound care instructions; pain medication is not typically prescribed for this procedure. Sutures are removed after 10-14 days, depending on the body location. Specimens should be submitted for pathologic examination.