# Transverse scar contracture mid abdomen



## tuzzi (Nov 2, 2012)

If someone could take a look at this I would really appreciate it. I do not code out alot of dermatology procedures. But was looking at code 14301. I believe this would include the complex repair, but not sure if the fasciotomy or the subcu fat flap is included in this code or would I need a separate code for these.

Large scar approximately 45cm across, marked for elliptical excision. Incision was carried down through the skin and subcu tissue to the abdominal wall fascia and dissection was then carried superiorly along the abdominal wall fascia releasing the subcutaneous and scar off of the abdominal wall fascia and carried superiorly. A second incision carried on the superior flap was then made and carried down through the skin into the subcu tissue. A triangular shaped flap of subcutaneous tisse was left to be used for the reconstruction. The scar contracture across the muscle fascia was then released with a vertical fasciotomy and the anterior rectus muscle fascia on both the left and the right side. the lower flap was then elevated down to the level of the umbilicus and laterally at the  fascia of subcutaneous layer this to allow for advancement of the superior flap of subcutaneous tissue and fat to be place underneath into this area of dissection to allow for elevation of this scar. The area was then pleased for bleeding controlled with cautery. The subcutaneous flap advancement in a large transverse Z-plasty technique was then performed. This was then held in place using 2-0 Vicryl suture in the subcu tissue, then a complex closure of the skin was then performed in multiple layers  using 2-0 Monocryl in the deep dermis, 3-0 Monocryl and running sub cu Monocryl and reinforced with tape.

Thank you!


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