ABSTRACT
Background@#Benign tumors of the forehead are highly prevalent and can cause facial asymmetry, discomfort, and psychological issues for patients. Generally, excision is performed via an incision directly over the mass, which can produce suboptimal cosmetic outcomes. Many methods involving remote incisions have been developed to conceal scars at the hairline. This study compared patient satisfaction after remote and direct incisional approaches. @*Methods@#We retrospectively enrolled 122 patients who underwent forehead mass excision at our clinic between January 2010 and May 2019 and compared the remote and direct removal of benign forehead lesions. Data on demographics, tumor size, operative time, imaging method, the incidence of complications, and pathological results were collected. Patient satisfaction was assessed via a telephone survey. The complications monitored included hypoesthesia due to nerve injury, wound dehiscence or necrosis, hematoma or seroma, and recurrence. @*Results@#A total of 79 patients underwent direct-approach mass excision, and 43 underwent excision with a remote approach. Lipoma was the most common tumor (70 patients), followed by osteoma (26 patients). Statistical analyses with the Mann-Whitney and Fisher exact tests revealed significantly higher satisfaction among the remote-approach group than among the direct-approach group (P<0.05). @*Conclusions@#From the perspective of scaring and complication, the group that removed forehead mass through remote approach had significantly better results than the group that removed through direct approach. However, patients’ perception of scar visibility strongly influenced their satisfaction. Therefore, a remote approach should be considered for patients who are concerned about cosmetic outcomes, and the patient’s hairstyle should also be considered.
ABSTRACT
BACKGROUND: Lipomas are common benign soft tissue tumors composed of mature white adipocytes, with histological features including a well-circumscribed and lobular mass covered with a thin fibrous capsule. However, lipomas that are poorly demarcated from the surrounding fat are often encountered during surgery despite a postoperative histological diagnosis. We investigated the complications associated with different types of lipomas. METHODS: This retrospective study included 119 patients who underwent lipoma excision and computed tomography (CT) imaging at our clinic between January 2011 and August 2018. We classified the lipomas as encapsulated or nonencapsulated according to the histology, CT findings, and clinical criteria. Nonencapsulated lipomas were defined as relatively heterogeneous without a distinct capsule, whereas encapsulated lipomas were homogeneous with a distinct capsule. The analyzed complications included delayed wound healing, which can cause prominent scarring, hematoma or seroma, and recurrence. RESULTS: Encapsulated and nonencapsulated lipomas were diagnosed in 89 (74.8%) and 30 (25.2%) patients, respectively. Encapsulated lipomas occurred most commonly on the head, whereas nonencapsulated lipomas occurred most commonly on the neck and trunk (P=0.000, P=0.002, and P=0.031, respectively). The Fisher exact test showed a significantly higher incidence of delayed wound healing for nonencapsulated than encapsulated lipomas (P=0.014). CONCLUSIONS: Preoperative classification of lipomas using CT imaging is important for predicting the incidence of postoperative complications. Direct excision is adequate for removing encapsulated lipomas. However, nonencapsulated lipomas might require alternative methods, such as ultrasonic liposuction, to prevent postoperative complications. Our results will help reduce the incidence of scarring by providing guidance on surgical methods.