Excision of deep subcutaneous mass, left shoulder and reconstruction Excision of deep subcutaneous mass, back and reconstruction

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.