Tumescent Liposuction And Excision Vs Surgical Excision: A Comparitive Study For Management Of Subcutaneous Lipomas

Abstract

AIMS AND OBJECTIVE: Lipomas are most common benign soft tissue tumor, occurring in about 1% population and in 4th to 6th decade of life. It is typically painless in subcutaneous plane. It requires excision only when it is symptomatic or for aesthetic purposes. They are typically removed by conventional surgical excision. Liposuction is a safe alternative and cosmetically better. Since liposuction alone has drawbacks of leaving capsule that predisposes to recurrence, it is combined with extraction. This study aims at comparing conventional excision with tumescent liposuction with excision for subcutaneous lipomas. The post-operative complications and the aesthetic value of the two procedures are compared. MATERIALS AND METHODS: This was a prospective study conducted at BLDEU’s Shri B. M. Patil Medical College Hospital and Research Centre, Vijayapura from Nov 2017 to May 2019 and included 92 patients with subcutaneous lipoma. These patients were divided into 2 groups liposuction with excision (L) and excision (C) group with 46 patients in each group. L group underwent liposuction with tumescent anaesthesia with excision through same incision and C group underwent conventional surgical excision. The postoperative pain, ecchymosis, bleeding, seroma and scar size were assessed. The cases were followed up to 3months. RESULTS: The lipomas in subcutaneous plane in various parts of the body mostly in extremities, back and nape of neck were studied. The size of the lipoma ranged from 2-10cm with mean diameter of 5cm and 5.1cm in group L and C respectively. The pain score with VAS score was 3.2 in Group L and 4.3 in Group C and is statistically significant with p-value <0.001. 24 patients (52.2 %) in Group L developed ecchymosis post-operatively and resolved in one week. This is statistically significant with p-value <0.001. 3 patients in Group L and 1 patient in group C developed hematoma. 4 patients in Group L and 5 patients in Group C developed seroma in large lipoma which resolved with no further intervention. 2 patients in Group L developed infection post-operatively. All the cases in group L has a scar of less than 1 cm and in L group the scar size was more than 1 cm. This is statistically significant with p-value <0.001. No recurrence has been noted in any of the cases in both the groups so far. CONCLUSION: Combined liposuction and excision is a much safer alternative for lipoma removal than surgical excision and cosmetically better inspite of having minor self-resolving complication like ecchymosis. But long term follow up needed to know the recurrence rate.