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Operative Note Practice Scenario – 5

Pre-operative diagnosis: Lipoma of right upper arm

Post-operative diagnosis: Lipoma of right upper arm

Name of procedure: Excision of lipoma from right upper arm with layered closure of 6 cm incision.

Indications: The patient is a 70 year-old female who has a mass on the upper right arm which has been present for several years and has slowly increased in size. She now comes in for elective resection.

Description of Procedure: The patient was taken to the operating room and placed in the supine position on the operating room table. The right arm was supported on a pillow and secured to the bed. The skin overlying the mass of the upper arm was prepped with Betadine and then draped in sterile fashion. The skin overlying the mass was then anesthetized with 1% lidocaine with epinephrine. A transverse 6 cm incision was made. Subcutaneous tissue was divided with electocautery down through subcutaneous fat until the capsule of the lipoma could be identified. The lipoma was then easily dissected free from all surrounding tissue. There was a feeder vessel exiting the deltoid muscle beneath it. This was treated with electrocautery. The mass was removed intact without problems and appeared to be a typical lipoma. The wound was inspected for hemostasis and with this assured, the subdermal tissues were closed with interrupted 3-0 Vicryl and the skin was closed with a running subcuticular stitch of 5-0 Monocryl. Steri-Strips, Telfa and Tegadem dressings were applied. The patient tolerated the procedure very well and was able to ambulate from the minor surgery room without difficulty.


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