Removal of small skin swellings is common in our practice. Patients usually get them removed for the following two reasons,
In most cases, removal of the swelling is a simple and straightforward procedure. It is usually carried out under local anesthesia in adults. Patients usually go home after the procedure and follow up as an outpatient for inspection of the wound and suture removal. In case a biopsy was done, the case is reviewed once again after the biopsy report.
One of the reasons why patients come to a plastic surgeon is due to the concerns relating to the postoperative scars. In other situations, the referrals are due to the relative difficulty in obtaining closure in regions such as folds near the eyes, mouth, or nose. In the majority of cases, we remove the swelling with a small margin of skin. This can vary based on the type of swelling. Some of them mandate a narrow margin while others require a wider margin. This is based on clinical presentation. Additional pre-operative investigations may be ordered in some cases.
The removal of swellings consists of two parts. First is the removal, resulting in a wound. And the second is the closure wherein the tissues are approximated to achieve optimal healing. In most cases, the second part is done with a straight line closure. However, this may not be possible in certain situations. This may be due to wide separation between the wound edges, or proximity to regions such as eyes, nose, or mouth. In such situations, we resort to techniques such as skin grafts or flaps. We make intelligent use of neighboring or distant tissues to effect good closure. Some of the swellings may not arise from the skin. They may originate from other structures like fat. Removal of such swellings gives us some liberty concerning the placement of the surgical wounds. Some orientation of the surgical scars may be associated with a better outcome compared to others. Knowledge about the orientation of optimal incision lines helps us give a better looking postoperative scar.
Removal of these swellings is associated with a good outcome in most individuals. A small subset of individuals tends to have problem scars. It is usually possible to predict the scarring tendency of an individual by observing previous scars on the body. Two possible adverse outcomes related to the tendency for stretched out scars and hypertrophic scars. Though scar hypertrophy can be treated, patients need to be aware of such a possibility.
Removal of skin swellings is a minor and safe surgical procedure with very little downtime. With good technique, it is possible to get good outcomes in most individuals.
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I like to keep it simple.