UPPER ARM LIPOMAS

In this area, one is already somewhat out of the danger zone, but instead, other difficulties arise for the surgeon: I have already operated on large lipomas within the biceps muscle. The muscle must be carefully protected, dissected from the lipoma surface, set aside, and reconstructed after tumor removal. It becomes more challenging on the front and outer side of the upper arm. Here, natural fat tissue is present, which extends deep to the bone and contains the most important nerves and blood vessels of the entire arm. This fat tissue is very specific and particularly soft. Lipomas in this area are, therefore, difficult to delimit, and, as often experienced, they merge without any recognizable boundaries into the deep, original fat tissue. That means, in the depth, there is usually no lipoma capsule left that could be surgically traced, so eventually, the tissue must be "intuitively removed" at a suitable point, which is not easy.

Example of a 59-year-old female patient with a large lipoma on the posterior upper arm

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

Here's a patient's story:

I operated on one of these cases along with the patient who had previously undergone surgery in a university clinic and was dissatisfied with the result. To my great surprise, I found a completely "gutted" upper arm fat compartment, with complete surgical removal of the entire original fat compartment tissue, leaving all major vessels and nerves - operated microsurgically and technically with care - exposed. All muscles were literally "skeletonized." However, this caused problems because an important natural anatomical compartment of this area was missing. Instead, a huge bursa had formed as a "replacement." Was it right to remove all the fat tissue at this point in order to avoid any lipoma recurrence at all costs? I find this at least debatable.

On the other hand, there are also smaller lipomas of the subcutaneous fat layer on the upper arm, which can be relatively easily removed and have nothing to do with the described patient case.

Postoperative Formation of Keloid Scarring

Example of a 56-year-old female patient with a keloid scar on her left upper arm

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