What is the treatment for an infected lipoma?

Treatment of Infected Lipomas

The definitive treatment for an infected lipoma is surgical excision with appropriate antibiotic coverage, which provides the best outcomes for morbidity and mortality by removing the source of infection and preventing complications. 1

Initial Management

• Begin broad-spectrum antibiotics immediately upon diagnosis of an infected lipoma to control the infection before definitive treatment 1
• Obtain wound cultures to guide targeted antibiotic therapy once results are available 1
• Pain management with appropriate analgesics should be initiated based on severity 2

Surgical Management

• Complete en bloc surgical excision is the standard treatment for infected lipomas 3
• The procedure should include:
  • Removal of the entire lipoma with its capsule 3
  • Thorough debridement of any infected tissue 1
  • Irrigation of the surgical site with antiseptic solution 1
  • Consideration of leaving the wound open if heavily infected (especially in cases similar to infected pilonidal cysts) 1

Antibiotic Therapy

• Empiric antibiotic coverage should initially target common skin flora, particularly Staphylococcus aureus 1
• Common pathogens identified in infected lipomas include:
  • Staphylococcus aureus 1
  • Staphylococcus schleiferi 1
  • Group A Streptococcus 1
• Adjust antibiotics based on culture results and continue for 7-14 days depending on severity 1

Post-Surgical Care

• Regular wound care with dressing changes until healing is complete 1
• Monitor for signs of persistent infection including:
  • Increasing pain 1
  • Fever 1
  • Purulent drainage 1
  • Spreading erythema 1
• Follow-up within 1-2 weeks to assess healing and remove sutures if applicable 1

Special Considerations

• Deep or large infected lipomas may require more extensive surgical approaches and longer courses of antibiotics 3, 2
• Recurrence rates are significantly lower with complete surgical excision compared to other techniques like liposuction 4
• Infected lipomas must be distinguished from infected atypical lipomatous tumors or liposarcomas, which require more aggressive management 5
• Surgical site infection rates following lipoma excision are approximately 2.3%, but may be higher in infected cases 1

Pitfalls to Avoid

• Incomplete excision of the lipoma can lead to recurrence and persistent infection 4
• Delaying surgical intervention may result in abscess formation, tissue necrosis, or systemic infection 1
• Failure to obtain cultures may lead to inappropriate antibiotic selection 1
• Misdiagnosis of an atypical lipomatous tumor as a simple infected lipoma may result in inadequate treatment 5