Giant submuscular lipoma: clinical, diagnostic, and treatment aspects

Minimal-Scar Segmental Extraction of Lipomas: Study of 122 Consecutive Procedures

BACKGROUND

Surgical extirpation of lipomas that occur in cosmetically conspicuous areas of the body leaves a visible scar that is usually disfiguring. Minimal-scar segmental extraction (MSE) employs a much smaller incision and extraction and is particularly useful in exposed parts of the body. It can be easily performed in an office setting.

OBJECTIVE

The objective of this study was to evaluate the merits of MSE in clinical practice. Unlike other reports in the literature that describe, anecdotally, minimally invasive methods of lipoma removal, our study examined a new method by carefully measuring the results in a larger group of consecutive patients treated using this technique.

MATERIALS AND METHODS

A retrospective study was performed using data from 91 consecutive patients with a total of 122 lipomas that were treated using MSE. MSE of lipomas consists of a small stab incision and blind dissection of the tumor followed by its extraction in a segmental fashion. This procedure involves small instrumentation, minimal dissection with preservation of contour, and complete removal of the lipoma, including substantial portions of the capsule. Clinical data, including complications, outcomes, and recurrence rates, were recorded.

RESULTS

The procedure was well tolerated by patients, who were pleased with the results, particularly the small scar. The incidence of complications was 1.6% (n = 2) and consisted of hematoma (n = 1) and seroma (n = 1). The recurrence rate was 0.8% (n = 1). No long-term morbidity was noted.

CONCLUSIONS

The technical ease with which the MSE can be performed, coupled with a low recurrence rate, makes it a very cost-effective operation. The smaller postoperative scars, rapid healing, and low morbidity allow for better patient acceptance. We recognize the advantages and limitations of this procedure and encourage its use in selected patients.

Giant lipomas: a series of 12 consecutive cases and a giant liposarcoma of the thigh

BACKGROUND

The clinical presentation and character of giant lipomas create diagnostic problems because of their close relationship with other mesenchymal benign and malign tumors. It is therefore of primary importance for the clinician to be familiar with epidemiologic and anatomic attributes of these lesions.

OBJECTIVE

To evaluate and compare epidemiologic and clinical characteristics of giant lipomas operated in our clinic.

METHODS

Twelve giant lipomas and one giant liposarcoma are included in the study.

RESULTS

There were seven females and six males. The patients ranged in age between 22 and 75. The tumor duration was between 2 months and 40 years. The smallest lipoma size was 10x5x3 cm, and the largest was 19x9x5 cm. Two of the lipomas were located intermuscular. Mild hematoma formation was observed in two patients. Histopathologic evaluation was done for all specimens, and one myxoid liposarcoma was encountered.

CONCLUSION

When dealing with giant lipomas, liposarcomas should always be included in the differential diagnosis.

Medial plantar perforator flaps with supermicrosurgery

Since the 1980s, the concept of the perforator flap has been modified to include new perforator flaps. A medial plantar perforator flap, which has no fascial component and is nourished only with perforators of the medial plantar vessel and a cutaneous vein, or with a small segment of the medial plantar vessel, was developed. A free medial plantar perforator flap was successfully transferred for coverage of a soft-tissue defect in the finger. The advantages of this flap are minimum donor site morbidity, minimum damage to the posterior tibial and medial plantar systems, no need for deep dissection, possible thinning of the flap with primary defatting, a short time for flap elevation, use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, a concealed donor scar, and possible application as a flow-through flap as a free flap and an island perforator flap for plantar weight-bearing defects.

Free medial plantar perforator flaps for the resurfacing of finger and foot defects

In this article, three cases in which free medial plantar perforator flaps were successfully transferred for coverage of soft-tissue defects in the fingers and foot are described. This perforator flap has no fascial component and is nourished only by perforators of the medial plantar vessel and a cutaneous vein or with a small segment of the medial plantar vessel. The advantages of this flap are minimal donor-site morbidity, minimal damage to both the posterior tibial and medial plantar systems, no need for deep dissection, the ability to thin the flap by primary removal of excess fatty tissue, the use of a large cutaneous vein as a venous drainage system, a good color and texture match for finger pulp repair, short time for flap elevation, possible application as a flow-through flap, and a concealed donor scar.