Post-Operative Assessment for Lipoma Removal at 2-Week Follow-Up
At the 2-week post-operative follow-up for lipoma removal from the back of a 35-year-old woman, the assessment should focus on wound healing, infection surveillance, and functional outcomes. 1, 2
Wound Evaluation
- Inspect the surgical site for:
- Complete wound closure and integrity
- Signs of infection (redness, warmth, swelling, purulent drainage)
- Adequate healing with proper approximation of wound edges
- Presence of any dehiscence or separation
- Abnormal scarring patterns (hypertrophic or keloid formation)
Infection Assessment
- Check for signs of surgical site infection, which occurs in approximately 2.27% of lipoma excision cases 3
- Evaluate for:
- Fever or systemic symptoms
- Pain that is worsening rather than improving
- Purulent discharge from the wound
- Surrounding cellulitis or lymphangitis
- Deep incisional infection (may require culture if present) 3
Functional Assessment
- Evaluate range of motion of the back and shoulders
- Assess for any functional limitations related to the surgical site
- Document any pain with movement or at rest
- Check for any sensory changes around the surgical site
Pathology Review
- Confirm the histopathology results match the clinical diagnosis of lipoma
- Verify that the margins are clear if there was any concern for atypical lipomatous tumor
- If MDM-2 amplification testing was performed (for larger or deeper lipomas), review these results 1, 2
Patient Education and Follow-Up Plan
- Provide wound care instructions if needed
- Discuss normal healing process and expected timeline
- Advise on activity restrictions or return to normal activities
- Educate on signs that would warrant immediate return (increasing pain, drainage, fever)
- Determine if additional follow-up is needed or if the patient can be discharged to primary care
Common Pitfalls to Avoid
- Don't miss signs of surgical site infection - these typically develop within the first two weeks and require prompt intervention with antibiotics and possibly drainage 3
- Don't overlook pathology results - ensure the excised tissue was indeed a benign lipoma and not an atypical lipomatous tumor which would require different follow-up 1
- Don't neglect patient education - patients should be instructed to return if there is any clinical suspicion of recurrence 1
Special Considerations
- For larger lipomas (>5cm), ensure complete excision was achieved as these have higher recurrence rates 2, 4
- If the lipoma was in a location near neurovascular structures, assess for any neurological deficits or vascular compromise
- If the patient had a giant lipoma (>10cm), evaluate for resolution of any pre-existing functional limitations 4
Following this assessment protocol will ensure proper healing and early detection of any complications after lipoma removal surgery.