Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Stanford, CA 94305, USA.
J Pediatr Surg. 2010 Apr;45(4):840-4. doi: 10.1016/j.jpedsurg.2009.12.016.
Benign subcutaneous lesions of the trunk are typically excised through overlying skin incisions, which can result in permanent, potentially disfiguring scars. We previously reported our experience with transaxillary subcutaneous endoscopic approach for removal of benign lesions of the neck. Here we report a similar approach for removing benign lesions of the trunk and lower extremity.
A retrospective review was conducted on 4 consecutive subcutaneous endoscopic procedures for benign truncal and lower extremity lesions from November 2006 to October 2008. The lesions included an anterior chest wall epidermal inclusion cyst, anterior midsternal dermoid cyst, left posterior chest wall giant lipoma, and a lipoma extending from the right gluteal crease onto the thigh. Outcome measures included need for conversion, cosmetic outcome, and complications.
All procedures were successfully completed using the endoscopic approach without conversion to open excision. There were no intraoperative complications. Postoperative complications included a 1 cm seroma at cyst site, axillary port site wound infection, and punctate dermal thinning secondary to adherent dermoid cyst, all resolved by 2 weeks postoperatively. All wounds healed with excellent cosmetic result at 1-month follow-up.
A subcutaneous endoscopic approach can be applied effectively to a variety of benign lesions of the trunk and lower extremities with adequate exposure for dissection and resulting in a quick recovery. Truncal and lower extremity scarring is absent, with small scars well hidden in either the axilla or the buttock, respectively.
通常通过皮肤切口切除躯干的良性皮下病变，这可能导致永久性的、潜在的毁容性疤痕。我们之前报告过经腋部皮下内镜切除颈部良性病变的经验。在此，我们报告一种类似的方法，用于切除躯干和下肢的良性病变。
对 2006 年 11 月至 2008 年 10 月期间连续进行的 4 例躯干和下肢良性皮下内镜手术进行回顾性研究。病变包括前胸部表皮样囊肿、前胸骨皮样囊肿、左胸壁巨大脂肪瘤和从右臀沟延伸到大腿的脂肪瘤。评估指标包括需要转为开放切除、美容效果和并发症。
所有手术均成功完成，无需转为开放切除。术中无并发症。术后并发症包括囊肿部位 1cm 血清肿、腋窝端口部位伤口感染和粘连性皮样囊肿引起的点状皮肤变薄，所有并发症均在术后 2 周内得到解决。所有伤口在术后 1 个月随访时均愈合良好，美容效果极佳。
皮下内镜方法可有效应用于躯干和下肢的多种良性病变，具有充分的暴露进行解剖，从而实现快速康复。无躯干和下肢的疤痕，小疤痕分别隐藏在腋窝或臀部，不易被察觉。
