UPPER ARM LIPOMAS WITH POSTOPERATIVE FORMATION OF KELOID SCARRING

Photo 1: The sole removal of the strongly constricting keloid scar resulted in a sudden, wide gaping of the surgical wound. This is a sign that the body recognized the high skin tension and reacted by producing excess scar tissue to counteract the tension. It's possible that the previous surgeon unnecessarily removed skin along with the lipoma.
The excised keloid scar extended histologically (microscopically) with long extensions deep into the subcutaneous fat tissue and was completely removed, as confirmed by histological examination.
Photo 2: Intraoperative surprise finding: All the muscles and the entire muscle compartment were essentially "gutted" down to the nerves in the depth, without any medically understandable reason. The dark node that I interpreted as a lymph node and removed during surgery turned out to be an encapsulated necrosis (dead tissue) upon histological examination.
Photo 3: Below the muscles, the major nerve bundles of the arm along with blood vessels originating from the depth were preserved intact. The surgical field was well managed.

Photo 4: As a replacement for the previously surgically removed healthy fat tissue, the body had apparently formed a large bursa (synovial sac) that covered the entire former wound area. I delicately removed this bursa to allow for a new adhesion of the layers and to address the patient's discomfort related to tissue instability. This fine, translucent tissue also proved to be scar tissue upon histological examination.
Photo 5: The end of the surgery with an aesthetically designed skin suture. As part of a multi-layer wound closure that accommodates tension, I used complex suture techniques to minimize tension on the outermost layer of the skin, allowing the new scar to heal better "in peace." This approach has proven effective.
NOTE: My motto in my profession: "The patient is always right!" Even when I don't find anything. Perhaps the dismissive university professor should adopt a similar motto. Because, as it turned out, this patient was unequivocally correct in her complaints.