# BCCA helical rim with advancement flap



## ebarker33 (Aug 15, 2014)

I* could really use some help on this chart*. Does the advancement flap include the advancement of the CARTILAGE?  Or is there a separate code for the CARTILAGE part of this procedure?  

THANK YOU IN ADVANCE for your help!!!  



PREOPERATIVE DIAGNOSIS:  Basal cell carcinoma right helical rim.

POSTOPERATIVE DIAGNOSIS:  Basal cell carcinoma right helical rim.

OPERATION:  Excision of basal cell carcinoma right helical rim with local tissue rearrangement Antia-Buck   advancement flap 10 sq cm.

ANESTHESIA:  Local.

ESTIMATED BLOOD LOSS:  10 mL.

COMPLICATIONS:  None.

SPECIMENS:  Frozen section:  Initial positive margin at the 9 o'clock.  Additional margin was excised and these were negative.

INDICATION FOR PROCEDURE:  71-year-old female who was seen my office,  evaluated for lesion of the right helical rim.  Shave biopsy turned out to be a basal cell carcinoma.  The lesion measured around 1 cm in diameter.  I offered the patient excision with closure.  I explained to him the procedure in detail including the risks, benefits and complications including bleeding, infection and recurrence.  He understood  would like to proceed.

DETAILS OF OPERATION:  After informed consent, he was brought to the operating room in stable supine position.  The right side of the ear was prepped and draped in sterile fashion.  I used 1% lidocaine with epinephrine and performed an ear block.  I then used 1% lidocaine to perform the hydrodissection along the helical rim.  I performed an excision of the lesion with a 3 mm margin.  This was taken through the cartilage as well.  The lesion was marked and sent for frozen section.  It was positive at the 9 o'clock position.  Additional tissue was excised.  These were negative for pathology for basal cell. 

I then proceeded to raise the anterior bulk flap.  On the upper side of the helical rim I performed a V-Y advancement and on the lower side, we performed advancement and my incision was along the helix anteriorly extending all the way down to the lobule.  I raised a skin and mucochondrial flap.  I left the posterior wall intact.  I performed elevation of the cartilage.  The cartilage was then advanced and anchored with a 4-0 Monocryl.  The tissues were advanced and then I closed, placed deep suture with interrupted 4-0 Monocryl and the skin was closed with 5-0 plain. 

The patient tolerated the procedure well.  He was taken to Recovery in stable condition.


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