PREOPERATIVE
DIAGNOSES:
1.
Enlarging and painful mass, back.
2.
Enlarging and painful mass, left shoulder.
POSTOPERATIVE DIAGNOSES:
1.
Enlarging and painful mass, back.
2.
Enlarging and painful mass, left shoulder.
PROCEDURES PERFORMED:
1.
Excision of deep subcutaneous mass, back and reconstruction.
2.
Excision of deep subcutaneous mass, left shoulder and reconstruction.
ANESTHESIA: 0.5% lidocaine with epinephrine
plus Neut.
COMPLICATIONS:
None.
INDICATIONS FOR SURGERY: This patient is a 69-year-old white male,
who was referred to my office by his physician, because of concerns of two
masses. One is located on the upper back
and the other was on the left shoulder area.
These have been getting larger in size and causing the patient
discomfort. A full consultation was
provided to the patient in the office discussing options for treatment and he
has elected to undergo excision and reconstruction. The potential risks and complications of the
surgical procedure were thoroughly discussed with him and include, but are not
limited to bleeding, infection, scarring, asymmetry, deformity, recurrence,
problems with healing, hypo or hyperpigmentation, hypertrophic or keloid
scarring, widening of the scar, and the need for further surgery. He is fully informed that there will be
scars. Scars are permanent, and no
guarantees can be given as to the final outcome, appearance, location, or
length of the scars. The patient states
he understands. All of his questions
were answered and he gives consent. Both
masses were identified and confirmed by the patient in the preoperative holding
area.
PROCEDURE IN DETAIL: The
patient was taken to the operating room, placed in a prone position, where both
areas were prepped and draped using sterile technique. A marking pen was used to outline the mass on
the back, which measured about 2 cm in diameter and the mass on the left
shoulder, which measured approximately 1.5 x 1 cm in size. Markings were made for excision, drawing incision
lines along least tension lines and natural skin creases, wherever possible,
and then infiltrating as a field block with a 0.5% lidocaine with epinephrine
plus Neut.
The back mass was excised first. A #15 blade was used to carry out the
incision through the skin and subcutaneous tissue, dissecting the subcutaneous
tissue around the mass. The mass
appeared to be a cystic mass in the deep subcutaneous tissue with some chronic
inflammation. The mass was excised by
continuing the dissection into the deep subcutaneous tissue excising the mass
in its entirety and submitting it to pathology for permanent sectioning. No other masses or abnormalities were noted.
Meticulous hemostasis was achieved. Gelfoam was used to secure the hemostasis,
and obliterate the dead space. The
defect was then closed in layers using multiple interrupted buried 4-0 Vicryl
sutures to approximate the subcutaneous tissue and dermis, followed by 4-0
Prolene in a subcuticular fashion. Total
length of repair was approximately 3 cm.
The lesion on the left shoulder was operated
on the similar fashion using a #15 blade to make the incision through skin and
superficial subcutaneous tissue identifying a mass, which was firmer and
appeared to be more chronic. It was
dissected from the surrounding superficial and deep subcutaneous tissue,
excising in its entirety and submitting it to pathology for permanent
sectioning. No other masses were
noted. Meticulous hemostasis was
achieved. Gelfoam was used to secure the
hemostasis and obliterate the dead space.
The defect was then closed using multiple interrupted buried 4-0 Vicryl
sutures to approximate the subcutaneous tissue and dermis, followed by 4-0
Prolene in a subcuticular fashion. Total
length of repair was approximately 2 cm Mastisol and Steri-Strips were applied
as dressings. The patient tolerated the
procedure well.
The patient was given written and verbal
instructions in regards to wound care, signs and symptoms of infection, and
followup. He was informed to call the
office if he has any questions or problems.
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