Lipomas are fatty tumors that are often located in the subcutaneous tissues of the head, neck, shoulder, and back . Lipomas have been identified in all age groups but usually first appear between age 40 and 60. Sometimes they run in families. Sometimes they are caused by previous injury. Most lipomas do not hurt unless they are squeezed or bruised.
Anatomy and Physiology of Lipomas
Lipomas are tumors of adipose tissue. They usually present as nonpainful, round, mobile masses with a characteristic soft, doughy feel to them. Most lipomas are asymptomatic, can be easily diagnosed on physical examination, and do not require any treatment. Microscopically, lipomas are composed of mature adipocytes arranged in lobules, many of which are surrounded by a fibrous capsule.
Most lipomas are completely benign, but there are some clinical features that may suggest malignancy :
- Extremely painful or exquisitely tender to the touch
- Larger than 5 cm
- Deeper than the subcutaneous skin
- Intra-muscular, or deep to fascia
- MRI appearance of the mass lacking the iso-intense signal of subcutaneous fat
When to Excise
Most lipomas do not cause any symptoms. However, many patients are concerned about the cosmetic appearance of the lipoma as a lump sticking out of their arm or other extremity. Moreover, the mass may interfere with movement of a joint or excursion of muscle tendons. Other patients notice slight soreness of a lipomatous mass located in their trunk at the beltline, bra strap, or with other tight clothing. Therefore, some patients elect to have the lipoma excised. A clear understanding of the anatomy and surrounding tissues of a lipoma is necessary for accurate excision.
How to Excise
First, one should identify the size and shape of the lipoma at the level of the skin. (It is often helpful to draw a circle outline of the approximate size and location of the mass on the skin). Next, plan a linear incision over the largest palpable area of the mass within Langers lines (i.e., natural skin creases). After sterile prep and drape, local anesthetic can be infiltrated as a field block in the subcutaneous tissue surrounding the operative field.
The first incision is made just through the skin and subcutaneous fat centered over the middle 1/3 of the palpable mass. The fatty tissue of the lipomatous mass should be easily identified separate from the subcutaneous layer. The center of the skin flap is grasped to visualize the lipoma easier. Next, a blunt instrument (e.g., scissors, curette, freer) is then used to tease (or dissect) the subcutaneous layer from the mass, exposing it from one side to another in alternating fashion to stay centered over the mass. This step takes a lot of time but should be performed meticulously so that you don’t inadvertently dissect any other tissue (e.g. blood vessel, nerve, fascia). The skin incision may be elongated in either direction for better visualization. Once a portion of the lipoma has been dissected from the surrounding tissue, a locking grasping clamp can be applied to the mass to provide traction for further removal. Once the lipoma is freed from all surrounding tissue, it can be delivered out as a whole.
Many of the dissection techniques that today’s students need to learn are not taught in a practical hands-on way. As an example, there exists a challenge in learning the theoretical concepts of lipoma excision in the classroom and taking them into the lab. Currently there are just not a lot of practice options on the market for lipoma excision that give the student life-like scenarios to develop their dissection and excision technique.
SurgiReal is the Solution
That’s where SurgicReal comes in. The SurgiReal Simulated Lipoma Tissue Pad is a high fidelity, life-like reproduction of a subcutaneous lipoma. Each Pad has two simulated lipomas embedded below life-like skin layers for the student to practice lipoma identification, excision, and closure/suturing. After skin incision, the lipoma will be identified. With meticulous dissection, the lipoma can be removed en masse. The skin can be suture closed after each procedure. The skin actually feels authentic and holds sutures just like real skin.
“Common things occur commonly” (Anonymous)
Lipomas are benign masses that present commonly to the primary care settings. Thus the ability to identify and remove lipomas is an expected skill for the healthcare professional. The SurgiReal simulated lipoma tissue pad provides the most realistic training model to practice your lipoma excision techniques.
- Salam G. A. (2002). Lipoma excision. American family physician, 65(5), 901-904.
- Johnson, C. N., Ha, A. S., Chen, E., & Davidson, D. (2018). Lipomatous Soft-tissue Tumors. The Journal of the American Academy of Orthopaedic Surgeons, 26(22), 779-788. https://doi.org/10.5435/JAAOS-D-17-00045