What happens during a subungual lipoma excision?
On the channel as “Subungal Lipoma Excision”
In this video Dr. Knight narrates the removal of a subungual lipoma, a fatty mass sitting under the nail bed and lifting the nail. He shows the MRI, the nail plate coming off, and the mass teased away from the undersurface of the nail bed by micro dissection. He then trims the stretched nail bed and repairs it with absorbable suture.
This is a transcript of a recorded talk from 2016. Any figures mentioned are from the recording and are not statements about current results or the practice.
Read the transcript 213 words
The transcript below is what Dr. Knight says in the video. We corrected the anatomy, drug and device names the automatic captions got wrong and added the punctuation and paragraph breaks. No words were changed, added or taken out. The uncorrected machine transcript is kept on file.
Transcript
Subungual lipoma excision. This patient had a long history, had a relatively painless mass that was elevating her nail bed. You can see the deformity there. This shows the MRI with the hypointense lesion scalloping out the distal phalanx.
Now I'm removing the nail plate. That shows a large bulging yellowish mass.
Looking at a mid-axial incision, the incision would likely not allow satisfactory removal of the mass, so the incision was made through the central portion of the nail bed. You can see the bulging fat beneath the nail bed. Using careful micro dissection, the lipoma was teased from the attachments to the undersurface of the nail bed.
You can see, as I remove the mass, that there is quite a concavity within the dorsal surface of the distal phalanx.
Final mass removal, and now exposing, or looking at, the distal phalanx. Now you can see there's quite a bit of redundancy to the expanded nail bed. Now you can see the mass, rather large, measuring, this pathology consistent with benign lipoma.
Due to the expanded nail bed, I felt that this should be, the redundancy should be excised, to allow for a typical nail bed repair. And finally the nail bed was repaired with 6-0 plain gut absorbable suture, knot placement.
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