# graft from excess - Would anyone be able



## AnneCline (Apr 6, 2011)

Would anyone be able to help with CPT's for this op note? I was going to use 14040 for the cheek flaps but what would you use for the graft to the nose? Wasn't sure since it was excess from the flap already being done for the other defect. Any help is greatly appreciated!


PREOPERATIVE DIAGNOSIS: Basal cell carcinoma of the left cheek and left
nasal ala

POSTOPERATIVE DIAGNOSIS: Same

OPERATIVE PROCEDURE: .....Reconstruction of the left cheek with bilateral
advancement flaps; reconstruction of the nose with skin graft
has a less than 1 cm, full-thickness cutaneous defect of the left
nasal ala as well as a much larger, approximately 3 cm x 2 cm, full-
thickness cutaneous defect involving the left cheek, oriented obliquely
over the nasolabial fold. I recommended reconstruction of the left cheek
with bilateral advancement flaps and reconstruction of the nose with a skin
graft from excess tissue from the cheek flap closure.

....A skin incision was created along the left nasolabial fold from the left nasal ala running obliquely and eventually curving along the cheek lateral to the oral
commissure. Both burrow's triangles were excised. Subcutaneous advancement flaps were elevated with significant dissection superiorly to allow the flap to move in an
inferior/medial direction preserving as much of the left upper lip as
possible without significant movement. The superior aspect of the burrow's
triangle excised tissue was trimmed and debulked and used as a full-
thickness skin graft for the left nasal ala defect. After the nasal alar
defect was debrided sharply, the graft was sutured in place with 5-0 fast-
absorbing gut and 5-0 Monocryl. The left nasolabial fold defect was then
reapproximated with 4-0 Vicryl buried along with 5-0 fast-absorbing gut and
5-0 Monocryl in simple interrupted fashion. Bleeding was controlled with
light electrocautery and direct pressure.


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