Dorsal and volar approach to managing a giant bilobed bicompartmental lipoma of the hand: case report

Background: Lipomas are common benign tumors, but giant bicompartmental bilobed lipomas in the hand are rare and pose unique diagnostic and surgical challenges due to the hand’s complex anatomy and the proximity of neurovascular structures. Case presentation: We report the case of a 67-year-old woman with a slowly enlarging, painless mass in her left hand, located between the second and third metacarpals, with both dorsal and volar extensions. Physical examination revealed a firm, well-defined lesion measuring approximately 5 cm in length, associated with mild paresthesia and decreased range of motion. Magnetic Resonance Imaging (MRI) confirmed a well-encapsulated, hyperintense mass consistent with a benign lipoma, exhibiting bicompartmental extension without signs of malignancy. A dual approach was employed for complete excision: an S-shaped dorsal incision followed by a volar zigzag incision. Intraoperatively, the lesion demonstrated a bilobed hourglass shape crossing through a constriction ring formed by surrounding anatomical structures. Meticulous dissection enabled safe en bloc removal while preserving the extensor tendons and common digital nerves. The postoperative course was uneventful. The patient resumed active motion two weeks postoperatively, with full recovery of hand function and no recurrence at 6-month follow-up. Histopathological examination confirmed a spindle cell lipoma with no malignant features. Conclusion: This case highlights the importance of preoperative imaging, surgical planning, and a dual dorsal-volar approach for managing complex lipomas of the hand. Tailoring the surgical strategy to the lesion’s anatomy allows complete excision while minimizing the risk to vital structures and optimizing both functional and cosmetic outcomes.