# Wedge Excision with layered closure of the ear



## JessH2618 (Sep 16, 2010)

Please see the below op note.  I'm good with the coding of the mohs, however, I'm somewhat stuck on the "wedge excision and layered closure of the ear" as the repair to the mohs defect.  Thoughts?

PROCEDURE:    Mohs Micrographic Surgery With Wedge Excision and Layered Closure of the Ear

PREOPERATIVE DIAGNOSIS:     Basal cell carcinoma 
POSTOPERATIVE DIAGNOSIS:     Same


LOCATION:     Superior helix margin of the left ear
PREOPERATIVE SIZE:     1.9 x 1.6 cm
POSTOPERATIVE SIZE:     2.7 x 0.5 cm
ANESTHESIA:     1% lidocaine with 1:100,000 epinephrine 
PREOPERATIVE MEDICATIONS:    None
POSTOPERATIVE MEDICATIONS:    Azithromycin 250 mg, 2 tabs day 1, then one tab daily for days 2 through 10, dispense 11 tabs;  Tylenol #3, 1-2 tabs q4-6h prn pain, dispense 21 tabs.


COMMENT:    The anesthesia used was 1% lidocaine with 1:10,000 epinephrine.  The skin was prepped in a sterile fashion with Betadine.  Histologic tumor-free margins were obtained in 2 stages and 2 pieces by standard Mohs micrographic techniques.  Postoperative size 2.7 x 0.5 cm.

Anesthesia with 1% lidocaine with epinephrine 1:100,000 and another sterile prep were performed.  A wedge excision was completed by carrying down an excision through the full thickness of the ear and cartilage with an inward facing Burow's triangle.  The wound was then closed in a layered fashion re-approximating the cartilage with 4-0 Vicryl sutures and re-approximating the dermis with 5-0 Monocryl sutures, and then re-approximating the epidermis with a running top suture of 6-0 Prolene.  This was completed after electrodesiccation to obtain hemostasis.  Postoperative length wrapping around the ear once this wedge was closed was 4.5 cm.  Estimated blood loss minimal.  Complications none.  Routine wound care


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## LCRUZ515 (Oct 4, 2010)

It appears to me that the physician is doing a complex closure. He is creating a defect (wedge excision) for repair.


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