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Report of an Intramuscular Lipoma within a Free Myocutaneous Flap: Systematic Review and Management
Elizabeth M. Kenny BS; Francesco M. Egro MBChB, MSc, MRCS; Tahsin Oğuz Acartürk MD
University
2019-02-15
Presenter: Elizabeth Kenny
Affidavit:
Vu T. Nguyen
Director Name: Vu T. Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: Lipomas are a common finding often of little clinical significance but can pose a challenge to the microsurgeon if discovered during flap harvesting, especially if found within muscle along the pedicle or perforators. We report a case where a well-circumscribed intramuscular lipoma was discovered within the muscle of a free myocutaneous right anterolateral thigh (ALT) vastus lateralis free flap.
Case Report: A 61-year-old man presented for reconstruction following resection of a squamous cell carcinoma of the left retromolar trigone extending into the mandible, maxilla, soft palate, and tonsillar fossa. Reconstruction was achieved using a free myocutaneous right ALT vastus lateralis free flap with a 21x8 cm elliptical skin paddle. During dissection of the descending branch of the lateral circumflex femoral artery, a well-circumscribed intramuscular lipoma impinging on perforators to the skin paddle was identified. The perforator was carefully dissected and detached from the lipoma without violating the thin capsule or exposing the lobular fatty structures. The specimen was sent for pathologic examination which confirmed a 7x4 cm benign right thigh lipoma. The rest of the case was uncomplicated with successful anastomosis and free flap survival.
Conclusion: Despite their high prevalence, the management of lipomas during flap harvesting has not been previously discussed in the literature. A systematic review was performed and an approach for the management of myocutaneous flaps containing a lipoma was described. Underappreciated considerations including lipoma location, growth pattern, and proximity to pedicle and perforators must be taken into account when evaluating a lipoma during flap harvest.
