NECK LIPOMAS AT THE BACK

The posterior neck has its peculiarities and characteristics that can make surgical removal of lipomas very difficult. I remember highly complex and complicated surgeries that a layperson would never expect (unfortunately, not even the private health insurance with its cost-oriented "trivialization drive"):
Typically, neck lipomas have to be operated on in a prone position, in the so-called "jackknife position," with the head bent forward, to better access the neck area. The space here is very tight intraoperatively. Sterile optimal coverage must also be applied, unfortunately, with a sterile cloth covering the head area, and the patients look and breathe freely downwards, towards the floor. Technically, there is no other way.

The posterior neck is a mechanically highly stressed region. Therefore, there are particularly hard, tough tissue structures that provide anatomical stability but can be operated on "like scar tissue" intraoperatively, making progress significantly slower. There are many cell-like tissue subdivisions here that one must pass through or operate through. Additionally, there is strong vascularity in this area, so there is bleeding during surgery, despite all measures. The high-quality operation, which requires mandatory hemostasis, is therefore additionally very demanding. To make it not too easy, many nerve fibers extend backward from the neck to the skin. These must be protected as much as possible.

In general, lipomas in this region are very firmly embedded in bleeding tissue, which can significantly slow down progress during surgery. The formation of fat tissue flap plasty is significantly more difficult due to the very firm tissue, but not impossible.
Postoperative treatment requires a specific approach, which may take some getting used to. The neck is very mobile, which happens intuitively without subjective control. To prevent postoperative bleeding into the surgical area and seromas, the head, along with the neck, must be placed in a "stiff" position and immobilized in this way. This prevents unintentional shear movement tension on the operated tissue.

Example of a 58-year-old man with signs of paralysis

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