Friday, 20 July 2012


New Outpatient Treatment (Day Surgery) For Lipomas:

Enucleation of Lipomas Followed By Sclerotherapy

A Lipoma is a benign (not causing death or harmless) tumor of adipose (fatty tissue) origin. The predisposing factors are:

1. Blunt Trauma

2. Familial (Genetic Disorder/Inherited)

It is diagnose by history (taking the patient's story) and physical examination. Ultrasound scan and other radiologic investigations, may further confirm the diagnosis and to plan the treatment method. A gross anatomical examination, followed by histopathologic (microscopic tissue diagnosis) evaluations are definitive.

The usual treatment in PNG, is wide excision of its capsule or sac (the tissue enclosing the fatty tumor tissue). However, the complications may be:

1. Haematoma and seroma formation

2. Infection

3. Scars

4. Joint Stiffness, if situated close to a joint area

5. Blisters (with improper dressing materials)

6. May require admission to the wards and general anesthesia 

(consumption of too much resources and manpower, for such a benign condition)

7. Longer recovery time (more morbidity or complications of operation)

We have introduced a new method to Goroka General Hospital:

1. Pin-hole Incision and Opening through the skin, into the Sac (May be ill defined sometimes) at the centre of the swelling/lump/bulge (skin elevation)

2. Enucleation of the fatty tissue (tumor) using a 'grabing/pinching instrument', introduced through the pinhole opening

3. The sac is completely freed of fatty (tumor) tissue

4. Sclerotherapy (treatment to cause hardening of tissue or scar formation) of the empty sac (dead-space)

5. Pressure dressing (with the pressure concentrated on the peripheries)  for 3 days (the pin-hole opening in the centre is left open for free drainage of old blood and serous fluid)

6. Follow-up review after 1 week, after 1 month and then after 1 year

The Advantages of this Method:

1. Minimizes haematoma and seroma formation

2. Minimizes risks of infection

3. May minimize the chances for recurrence

4. Almost scarless

5. Faster recovery (less morbidities or complications of operation)

6. No need for admission to the wards and general anaesthesia (minimal use of resources and manpower time, which is suitable for PNG conditions.

*A Photo Showing, Complications of Older Method (Common Method in PNG)

*Photos Showing Better Outcomes of Newer Improved Method in PNG

*The excessive/remnant skin and darkening, will resolve, over time (the excessive skin will naturally re-drape itself)

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