LIPOMA and SEBACEOUS

CYST
Irwan Saputra Batubara
13294
Koass Bedah Klaten

Lipoma
A lipoma is a growth of fatty tissue that
slowly develops just under the skin.
Lipoma can form on any part of the body,
typically appear on the neck, shoulders,
back, abdomen, arms, and thighs.

 This condition is
most prevalent in
adults between the
ages of 40 and 60
(Mayo, 2012).

 Rarely, lipomas can be associated with

syndromes such as hereditary multiple
lipomatosis, adiposis dolorosa, Gardner's
syndrome, and Madelung's disease.
There are also variants such as
angiolipomas, neomorphic lipomas,
spindle cell lipomas, and adenolipomas.

 A rare condition is Dercum's disease

(adiposis dolorosa), characterized by
irregular painful lipomas most often found
on the trunk, shoulders, arms, forearms,
and legs.
Dercum's disease is 5 times more common
in women in middle age, and has psychic
disturbances as other prominent features.

Sign and Symptom

Lipomas usually present as:

Nonpainful nodule
Round and lobulated
Mobile masses, with a characteristic soft.
The overlying skin appears normal.
Lipomas can usually be correctly
diagnosed by their clinical appearance
alone.

 The lipoma is only

painful if it grows
into nerves
underneath the
skin.

 Biopsi and MRI

has been used to
differentiate
lipomas and
liposarcomas.

Treatment

Nonexicional Techniques
a.Steroid injections result in local fat atrophy,
thus shrinking the lipoma
b.Injections are best performed on lipomas less
than 1 inch in diameter.
c. 1:1 mixture of 1% lidocaine and triamcinolone
acetonide (10 mg/mL) is injected into the
center of the lesion
d.This procedure may be repeated several
times at monthly intervals.

Excisional Technique
Proposed incision
removing skin over
the lipoma.
The palpable
borders of the
lipoma are marked
to aid the surgeon
in complete
removal.

 Once freed, the

lipoma is delivered
as a whole, and
hemostasis is
achieved

 Interrupted 3-0 or
4-0 Vicryl sutures
are used to
partially close the
dead space.

 The skin is then closed with interrupted 40 or 5-0 nylon sutures.

A pressure dressing is placed to reduce
the incidence of hematoma formation.
The patient is given routine wound care
instructions, and the wound is checked in
two to seven days.

 The sutures are removed after seven to

21 days, depending on the body location.

Sebaceous Cyst
A sebaceous cyst is a closed sac under
the skin filled with a cheese-like or oily
material.
The most common cause of is rupture of a
pilosebaceous follicle associated with acne.
Other causes include a developmental defect
of the sebaceous duct or traumatic
implantation of surface epithelium beneath
the skin.

Sign and Symptom

The main symptom
is a small, fluctuated
non-painful lump
beneath the skin.
Found on the face,
neck and trunk.
It usually grows
slowly and is not
painful

 The cyst is typically

filled with white
flakes of keratin.
Most cysts are soft
to the touch.
Usually there is a
punctum on the top
of the swollen.

 In infected or inflamed
lump:
Skin redness
Tender or sore skin
Warm skin in the affected
area
Grayish-white, cheesy,
foul-smelling material that
drains from the cyst

Treatment
After doing the
infiltration
anesthesia and
clean with
antiseptic, cover
the skin around the
site of the cyst with
sterile drapes.

 Incise the skin up to

the subcutan tissues
using a scalpel.
Using blunt and
sharp dissection,
identify the plane
between the cyst
and surrounding
subcutan tissues.

 Press the normal

surrounding skin
and soft tissues on
both sides gently
with the thumbs,
first in one
direction, then at
90 degrees to the
previous direction.

 Gently lift up the

incised ellipse of
skin and attached
cyst with forceps,
and separate the
deep pole of the
cyst from
underlying tissues
using scissors.

 Ensure
haemostasis and
close the skin with
non absorbable
interrupted
sutures. e.g. 6/0
Ethilon.

Follow Up
Check the bleeding
Check the sign of infection
The sutures are removed after seven to
21 days, depending on the body location

Reference
Pubmed: Sebaceous cyst
American Family Physician: Lipoma