GROIN LIPOMAS

Lipomas in the groin area are relatively rare. However, they also have their peculiarities. Important nerves, blood, and lymph vessels run relatively close to the skin surface in the groin. All of them must be preserved during the surgery. This can be achieved by accurately following the lipoma capsule surface during the preparation.

Patient Story:
A middle-aged, well-groomed, professional musician had developed a mandarin-sized, very bothersome, single lipoma in the groin area. The operation itself was not a problem, quickly completed, and, in my opinion, the aesthetic skin suture was very well done. The check-up the next day was inconspicuous, and the patient was completely pain-free. However, when the patient came back for a check-up after 6 days, part of the skin around the suture had become necrotic, leaving a very surprised Plastic Surgeon. I was not used to this at all. However, the patient convincingly assured me that she had been "very careful" and I believed her, but I shortly called her in again. The necrosis increased, and everything moved towards "secondary wound healing," meaning the wound would temporarily open under the dead skin. I pondered and pondered because I had certainly done nothing wrong. Until I finally realized: The patient was a musician. And she played music sitting down. But when sitting, she partly cut off the blood supply to her (pain-free) wound edges, until they died off in the least well-perfused areas. But she had deliberately spared herself, just in a sitting position, not lying down or standing, where the legs would be extended at the hip joint, and the skin blood flow would not be permanently "clamped." If she had stood up or laid down from time to time, the necrosis would certainly not have occurred. But she was busy playing music, as she was used to. Should I, as a surgeon, have foreseen that?

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