Excision of Benign Subcutaneous Tumours

(Dermoid cyst, epithelial cyst, lipoma).

Skin sutures are usually sufficient after extirpation of subcutaneous tumours.
The greater the amount of foreign bodies (subcutaneous stitches), the greater the tissue reaction.

Procedure

1. Mark the site of the incision [Figure 81].
   Figure 81
2. Apply iodine to the surgical area.
3. Cover with a sterile fenestrated drape.
4. Establish a field block around the tumour and also inject local anaesthetic under the tumour to elevate it. In addition, infiltrate the skin at the site of the incision [Figure 82].
   Figure 82
5. Make a longitudinal incision across the tumour [Figure 83].
   Figure 83
6. If necessary, place a wound spreader or two retractors in the opening
   [Figure 84].
   Figure 84
7. In the case of dermoid or epithelial cysts, separate the cyst from its surroundings by moving the dissecting scissors in a spreading motion while keeping the tumour in place with surgical tweezers.
8. Extirpate the tumour, including the capsule [Figure 85].
   Figure 85
9. For lipomas, the tumour can be dissected freely and the capsule can be incised, whereby the contents emerge.
10. Deposit the tumour in a container filled with formalin 10%.
11. Staunch the bleeding by binding the blood vessels.
12. If necessary, make a few subcutaneous sutures using reabsorbable material [Figure 86]. Avoid creating dead spaces.
    Figure 86
13. Make skin sutures with non-reabsorbable atraumatic thread [Figures 87-89].
    Figure 87
    Figure 88
    Figure 89
14. Apply a wound covering bandage or, if necessary, a pressure bandage.