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A 49-year-old patient with no significant past medical history presented with a gluteal lipomatous swelling. Surgical excision with skin ellipse was planned because of the size and localized nature of the lesion, with the aim of complete removal and satisfactory contouring of the gluteal region.
The patient was placed in the left lateral position under spinal anesthesia , and the operative field was prepared and draped in the standard sterile fashion. An elliptical skin incision was designed over the swelling to include the redundant overlying skin and facilitate primary wound closure.
The skin and subcutaneous tissues were incised, and careful circumferential dissection was performed around the lipomatous mass using sharp dissection. The mass was progressively mobilized from the surrounding tissues and completely excised en bloc together with the elliptical segment of overlying skin. Meticulous hemostasis was achieved.
The wound was closed primarily in layers. The deep subcutaneous tissues were approximated with interrupted 2-0 Vicryl sutures using a round-bodied needle, followed by interrupted 3-0 Prolene skin sutures using a cutting needle. The skin edges were accurately approximated with satisfactory eversion.
No drain was inserted. The patient tolerated the procedure well, with no intraoperative complications. The excised specimen was sent for histopathological examination.
The patient was placed in the left lateral position under appropriate anesthesia. The gluteal region was exposed, prepared, and draped in the standard sterile fashion.
The gluteal lipomatous swelling was identified and marked. An elliptical skin incision was designed over the lesion, incorporating the redundant overlying skin.
The incision was made through the skin and subcutaneous tissue. The lipomatous mass was carefully dissected circumferentially from the surrounding tissues using sharp and blunt dissection. The lesion was completely mobilized and excised en bloc together with the overlying elliptical skin segment.
Meticulous hemostasis was achieved.
The wound was closed primarily in layers. The deep subcutaneous tissues were approximated using interrupted 2-0 Vicryl sutures with a round-bodied needle. The skin was closed using interrupted 3-0 Prolene sutures with a cutting needle, achieving satisfactory approximation and eversion of the skin edges.
No drain was placed. The excised specimen was sent for histopathological examination.
skin and subcutaneous swellings
no specific contraindications
Scalpel handle with No. 21 blade
Toothed tissue forceps
Mosquito artery forceps
Langenbeck retractors
Needle holder
Electrocautery device
2-0 Vicryl sutures with a round-bodied needle
3-0 Prolene sutures with a cutting needle
Sterile surgical drapes and standard wound dressing
The patient was positioned in the left lateral decubitus position to provide optimal exposure of the gluteal swelling. The operative site was adequately exposed, and the patient was secured in position with appropriate padding of pressure points.
The gluteal region was prepared with an appropriate antiseptic solution and draped in a standard sterile fashion. The surgical team was positioned to allow comfortable access to the lesion.
Standard surgical instruments, electrocautery, suction, and sutures were prepared and available. The specimen container was prepared for submission of the excised mass for histopathological examination.
A 49-year-old woman with no significant past medical history was evaluated preoperatively for elective excision of a gluteal lipomatous swelling.
A complete history and physical examination were performed, including assessment of the size, consistency, mobility, and extent of the swelling, as well as the condition of the overlying skin.
Routine preoperative investigations were performed according to the planned anesthesia and the patient's clinical status, including:
Complete blood count (CBC)
Renal function tests and serum electrolytes
Liver function tests
Coagulation profile
Blood glucose
viral markers
Electrocardiogram (ECG)
Pregnancy testing when clinically applicable
Anesthesia assessment and fitness for surgery
The patient was assessed as suitable for elective surgical excision.
Anatomy and Landmarks
The gluteal region is composed primarily of the gluteus maximus, gluteus medius, and gluteus minimus muscles, with the subcutaneous tissue and skin forming the superficial layers.
For this procedure, the main anatomical landmarks were the iliac crest superiorly, the sacral region medially, the gluteal fold inferiorly, and the greater trochanter laterally.
The lipomatous swelling was localized within the subcutaneous tissue of the gluteal region. The skin and subcutaneous tissues overlying the mass were assessed before incision to determine the appropriate elliptical skin excision.
Careful dissection was performed along the plane between the lipomatous mass and the surrounding soft tissues. Particular attention was paid to maintaining hemostasis and avoiding injury to deeper muscular structures and the underlying neurovascular structures.
The extent of the elliptical skin incision was planned according to the size of the lesion and the amount of redundant overlying skin, allowing adequate exposure and subsequent tension-free primary closure.
no complications
No conflicts to disclose
Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, eds. WHO Classification of Tumours of Soft Tissue and Bone. 4th ed. International Agency for Research on Cancer; 2013.
McCarthy EF. Pathology of the Soft Tissue. In: general surgical pathology references. Lipoma is the most common benign mesenchymal tumor of adipose tissue.
Standring S, ed. Gray's Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. Elsevier; 2020.
Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. 9th ed. Wolters Kluwer; 2023.
Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Elsevier; 2022.
Brunicardi FC, Andersen DK, Billiar TR, et al, eds. Schwartz's Principles of Surgery. 11th ed. McGraw-Hill; 2019.
Gurtner GC, Evans GRD. Advances in tissue engineering and wound healing relevant to surgical wound closure. Plast Reconstr Surg. 2000;106(3):710-718.
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