Lipoma Removal


Lipoma Removal Consent Form


Sterile gloves (1 pair)

15 Blade Disposable Scalpel (1)

Iris Scissors, Straight (1 pair)

Needle Driver (1 pair)

Toothed Pickup (1)

Suture: Assorted (if specific suture not requested by provider)

10 ml syringe (1)

18 gauge 1.5 inch needle (1)

27 gauge 1.25 inch needle (1)

ChloraPrep 3mL stick (1)

Alcohol Swabs (4)

Sterile 4x4 gauze (5)

Sterile 2x2 gauze (2) 

Paper Medical Tape (1 roll)

Exam-room sheet (1 sheet, when necessary due to location of area to be excised)

Chux Pads (1)

Formalin cups (as many cups as specimens)

1% or 2% lidocaine:  If fingers, toes, penis, or nose - then without epinephrine.  Otherwise it is ok to have epinephrine.   (1 vial with minimum 20 mL remaining)

Procedure Note


The procedure was explained in detail and informed consent was obtained from the patient.  The area was prepped and draped in a sterile fashion, and infiltrated with _ mL of _% lidocaine with_ epinephrine for local anesthesia.  The lipoma was palpated superficially under the dermis.  An incision was made directly over the lipoma, and gentle blunt dissection was performed to free and then remove the lipoma.  The specimen was placed in specimen jar and sent for analysis.  Closure was performed with _ simple interrupted sutures using _ type of suture.  Petroleum ointment and a bandage were applied.  EBL was less than 1 ml.  Good hemostasis.  There were no complications.  Patient instructed to follow up for fever, erythema, swelling, pain, or purulent discharge from the wound.  The patient voiced understanding.  Suture removal in _ days.

Time Until Suture Removal

Duration of time to leave sutures