How to safely remove a neck mass, lymph node.
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Dr Kevin Soh describes how a neck mass or lymph node is removed.
3 Mount Elizabeth, #07-02, Mount Elizabeth Medical Centre, Singapore 228510
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0:09 – Case Presentation: A 40 year old lady has a mass on the left side of her neck, measuring 3 cm in size. The mass lies close to the external jugular vein. I can hide her scar by making my incision on the lower skin crease.
0:35 –Surgery video demo: I inject lignocaine (to reduce post-operative pain) and adrenaline (to induce vasoconstriction and reduce bleeding during surgery). I stretch the skin tight in order to facilitate neat skin incision. Because of the adrenaline, the incision is dry and bloodless.
1:11 – I have just cut through the epidermis and dermis. Next, I have to go through the platysma muscle, and search for the mass in the subcutaneous fat. The mass lies in the subcutaneous fat.
1:34 – Surgery is like painting. I use fine gentle strokes. Now I am identifying the platysma muscle. I cut through the platysma muscle.
2:18 – There are important structures in the neck that I need to look out for. Spinal accessory nerve supply motor fibers to the sternomastoid and trapezius muscles. Greater auricular nerve receives sensation from the skin below the ears.
2:44 – I dissect the subcutaneous fat to remove the mass. The mass has to be separated from all its attachments before it can be delivered.
4:41 – I close the wound in layers. I start by suturing the platysma muscle. I suture the platysma muscle in such a way that the knot is buried deep in the wound.
5:33 – Next, I suture the dermis. The needle must bite just the right amount of dermis in order to obtain perfect skin apposition. It is very important to bury the knot. The sutures used for platysma and dermis closure are absorbable sutures. They do not need to be removed. They are absorbed through the process of inflammation.
6:17 – Finally I close the epidermis. Instead of interrupted sutures, I use a continuous subcuticular suturing technique. The epidermis closes when I pull both ends of the suture. For the epidermis, I use non-absorbable sutures that need to be removed 7 days later. Non-absorbable sutures cause less inflammation and scarring. The end result is a very nice cosmetic aesthetic concealed invisible scar.
7:17 – All suture knots (especially absorbable sutures) have to be buried. Unburied absorbable suture knots will result in suture abscess, pain and redness. I also avoid interrupted sutures for the epidermis, because they cause ugly rail-road track or caterpillar marks. Steristrips are applied to provide strength to the wound. They also cover the wound and prevent contamination.
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