What are the post-operative care instructions for lipoma (fatty tumor) excision on the buttock?

Post-Operative Care for Lipoma Buttock Excision

Following buttock lipoma excision, implement early mobilization within 30 minutes on the day of surgery, maintain the surgical site clean and dry, remove urinary catheter within 24 hours if placed, and monitor for wound complications with specific attention to hematoma formation which requires immediate drainage. 1

Immediate Post-Operative Period (Day 0-1)

Wound Management

• Keep the surgical site clean and dry with standard dressing changes as needed to prevent infection 1
• Monitor closely for hematoma formation, which is considered tumor contamination in soft tissue excisions and must be drained promptly if it occurs 1
• Avoid routine drain placement unless specifically indicated for large excisions; drains should be removed early when used 1
• Apply compression to the surgical site to minimize fluid accumulation and reduce risk of seroma formation 2

Pain Control

• Administer multimodal opioid-sparing analgesia combining paracetamol and NSAIDs as first-line agents 1
• Use opioid-containing medications only as a last resort and in low doses 1
• Expect dull pain at the tumor site for approximately 1 week, which is normal following blunt dissection techniques 3

Mobilization and Activity

• Begin mobilization within 30 minutes on the day of surgery, progressing to 6 hours per day thereafter 1
• The buttock location may require modified positioning to avoid direct pressure on the surgical site initially 1
• Patients can resume normal daily activities as tolerated, avoiding strenuous activity involving the surgical area for 2-4 weeks 4

Early Post-Operative Care (Days 1-7)

Catheter and Tube Management

• Remove Foley catheter within 24 hours after surgery in the majority of cases, individualizing only for patients at high risk of urinary retention 1
• Nasogastric tubes should not be routinely used and should be avoided 1

Nutrition and Hydration

• Encourage oral fluids as soon as the patient is lucid after surgery 1
• Offer solid food within 4 hours after surgery 1
• Discontinue intravenous fluids by postoperative day 1 1

Monitoring Parameters

• Monitor vital signs including respiratory rate, heart rate, blood pressure, oxygen saturation, level of consciousness, and surgical site appearance 1
• Watch specifically for signs of infection, wound dehiscence, or hematoma formation 1

Wound Healing Phase (Weeks 1-4)

Suture and Dressing Care

• Follow standard wound care protocols with dressing changes as needed until sutures are removed (typically 10-14 days for buttock location) 4
• The incision should heal completely within 4 months with proper care 4

Activity Restrictions

• Avoid prolonged sitting or direct pressure on the surgical site during initial healing 1
• Gradually increase activity as wound healing progresses 4

Long-Term Follow-Up

Discharge Planning

• Following surgical excision and post-operative wound care, patients can be discharged to primary care with low risk of recurrence 5
• Re-referral is only necessary if there is clinical suspicion of recurrence 5
• Recurrence rates for properly excised lipomas are low, particularly when complete en-bloc resection with negative margins was achieved 1, 5

Common Pitfalls to Avoid

• Do not ignore post-operative hematomas - these must be drained as they are considered tumor contamination and increase recurrence risk 1
• Avoid inadequate compression in the immediate post-operative period, which can lead to seroma or hematoma formation 2
• Do not delay mobilization - early activity reduces complications and improves recovery 1
• Avoid routine use of drains unless specifically indicated, as they do not improve outcomes in most cases 1

Red Flags Requiring Urgent Evaluation

• Rapidly expanding hematoma or seroma 1
• Signs of wound infection (increasing pain, erythema, purulent drainage, fever) 1
• Wound dehiscence 1
• Neurological symptoms suggesting nerve injury 3