In this episode of The PODdoctors podcast, Dr. Damien Dauphinee, a board-certified foot and ankle surgeon, and Dr. Raafae Hussain, a fellowship-trained foot and ankle surgeon, discuss the excision of a lipoma, a benign fatty nodule that can cause pain in the foot and ankle. They explain that lipomas are commonly found in the subcutaneous layer of the foot and ankle, and while they are usually benign, they can become painful. The doctors emphasize the importance of clinical diagnosis, as an MRI may not show whether the lipoma is causing pain. They also mention that lipomas are often misdiagnosed as underlying ankle sprains. The surgical procedure involves making an oblique incision along the relaxed skin tension lines, carefully dissecting the lipoma, and removing it as a solid piece. The doctors highlight the need to identify and protect the lateral branch of the superficial peroneal nerve during the procedure.

QUOTES:

"You can get something called lipidema, and that's a different animal where a known normal fatty deposit can become painful. A lipedema can be a real problem in different parts of the body, and that's a normal place for adipose tissue. But if it becomes painful, sometimes we have to consider removing it. I've not appreciated that as much over the years as I do now. I think I'm seeing that that can become a source of pain all by itself in some patients. And I think it's probably a poorly understood problem." -Dr. Damien Dauphinee

“So we get the closure on this and you'll see we'll do deep to superficial. The reason we do that is so the knot stays buried. It's not close to the skin. So when she ends up tying this, you'll see that the knot will stay nice and low and hopefully the patient won't ever feel it. And then as time goes on, the weeks go on, the stitches will dissolve away, and hopefully no more score. There no more palpable nodule there using.” -Dr. Raafae Hussain

Top Takeaways:

• Lipomas are benign fatty nodules that can cause pain in the foot and ankle.
• Lipomas are commonly found in the subcutaneous layer and can be misdiagnosed as ankle sprains.
• Clinical diagnosis is crucial, as an MRI may not show whether the lipoma is causing pain.
• Surgical excision involves making an oblique incision along the relaxed skin tension lines and carefully dissecting the lipoma.

What You Will Learn:

• Surgical procedure for lipoma excision 
• Importance of dissecting carefully to avoid nerve damage 
• Closure technique: two layers, running subcuticular, deep vertical mattress 
• Superficial dressing choice: zebra foam
• Post-op shoe preference
• Risks: injury to lateral dors-cutaneous nerve branch, stunt neuromas

Resources:

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