# Nasolabial Flap OP Note



## companey (Oct 20, 2017)

Good afternoon All
I am new to codding Dermatology and this new OP note I received just has me confused.  I have been doing research which has made me more lost.  Can you please take a look at this OP Note and lead me in the right direction I would really appreciate it.

Operative Note

Preoperative Diagnosis: Mohs defect, left nasal ala through-and-through

Operation Performed: A nasolabial flap folded on itself for reconstruction of the left nasal ala together with nasal lining.

Procedure: This patient was place on the operating table in the supine position. She had undergone Mohs surgery of the left nasal ala  which left a defect measuring 2 x 1 cm externally and 1 x 1 cm internally. It was a through-and- through defect of the nasal ala and represented a fairly large notch.

It was thought to reconstruct this defect that two flaps would be necessary; however, a long nasolabial flap was designed to try and see if it could be repaired with just the one flap.  If a second flap were to be required it would be from the nasal septum.

A nasolabial flap was designed on the left side and this extended down the nasolabial groove to almost the corner of the mouth.  It was based, of course, superiorly.  The whole area was infiltrated with 1% Xylocaine and 1:100,000 parts epinephrine.  Incisions were then made with a scalpel into the subcutaneous tissues.  The distal portion of the flap was raised very superficially, but as the base of the flap was reached it became a little thicker to insure good blood supply. It was actually raised up onto the side of the nose.  Hemostassis was necessary because of prolific bleeding and this was achieved using a Bovie.  The cheek skin was undermined to about 2 cm in a sort of reverse facelift.  The nasolabial defect was then closed with deep sutures of 4-0 Monocryl and interrupted 5-0 Prolene to the skin.  The flap was then draped into the defect which it seemed to inhabit extremely comfortably. it was folded on itself and found to be far too long for the requirements.  It was clear that the defect including the lining of the nose could be repaired using the nasolabial flap on itself.  That portion which was to be folded was the thinnest portion of the flap.  The distal portion nevertheless had to be removed since the flap was too long.  The flap was sutured into position with interrupted sutures of 5-0 Prolene externally and internally interrupted sutures of 5-0 chromic catgut.  Bacitracin ointment was applied to the wound and a dry dressing was also applied.  the patient was warned that there might well be some oozing overnight and she was told to sleep propped up and put a towel on her billows.  She was then told that she could start showering tomorrow and was encouraged to get the area wet and to cleanse it.  She will be seen in about a week for suture removal.

Thank You for your help!!!


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