GROIN LIPOMAS

Lipomas in the groin area are relatively rare. However, they have their own unique characteristics.
In the groin, important nerves, blood vessels, and lymph vessels run relatively close to the skin surface. It is essential to protect all of these during surgery. This can be achieved by meticulously adhering to the surface of the lipoma capsule during preparation.

Patient Story:
A middle-aged, well-groomed patient developed a single, very troublesome lipoma in the groin area about the size of a mandarin. The surgery itself was actually not a problem, completed remarkably quickly, and in my opinion, the aesthetic skin suture was very well done. The follow-up the next day was unremarkable, and the patient was completely pain-free. However, when the patient returned for a follow-up six days later, part of the skin around the suture had died (necrotic), leaving a very surprised plastic surgeon. This was not something I was accustomed to. Yet the patient convincingly assured me that she had "taken very good care" of herself. I believed her but asked her to come back on short notice. The necrosis grew larger, and everything was heading towards "secondary wound healing," meaning the wound would temporarily open under the dead skin. I pondered and pondered, convinced that I had not done anything wrong. Until I finally understood: The patient had a predominantly sedentary job and sat for long periods each day. But in sitting, she partially compressed the blood supply to the (painless) wound edges, causing them to die in the least well-perfused areas. But she had deliberately taken care of herself, only in sitting, not in lying down or standing, where the legs would be extended at the hip joint and thus the skin circulation would not have been permanently "clamped." Had she stood up or lain down now and then, necrosis would surely not have occurred. But she was diligent in her job, as she was accustomed to. Should I, as a surgeon, have foreseen this?

Example of a 59-year-old female patient with a painless tumour above the left hip bone

Photos: Dr. Roman Fenkl, with the written consent of the patient