# Excision left labial varicosity, Partial Vulvectomy



## angel80 (May 29, 2013)

Looking for any input on this case that I can get. 

For this case, I was looking at 15839 v/s 56620. I always question the use of 56620 b/c it states that "the physician removes part or all of the vulva to treat premalignant or malignant lesions". See note below..

Diagnosis:
1. Left labial pain with cystic mass
2. Labial asymmetry

Proceudres performed:
1. Excision of left labial varicosity 
2. Partial vulvectomy. 

Procedure in detail:
After adequate general anesthesia was achieved, the patient was prepped and draped in the dorsal lithotomy position in candy-cane stirrups. The cystic mass was palpable. She did have some surface changes consistent with the varicose vein. We opened the labial majora skin lateral to the clitoris and lateral to the fold of the labia majora. We then made an elliptical skin incision to remove some of the excess labial skin. The incision was 8 cm in length. We then dissected down to the cystic mass, which was noted to be a large varicose vein. We undermined the vein and put a suture around it and ligated it. We then did this distally. Good hemostasis was noted, and the varicose portion was excised. We then removed some subcutaneous tissue and the elliptical piece of skin we had incised. The defect was the sewn subcutaneously using interrupted sutures of 2-0 Vicryl to close the dead space. The skin was then closed using 3-0 Vicryl in a subcuticular fashion after hemostasis was noted. Total hemostasis was gained with the Bovie. During the remainder of the surgery, there was no enlargement of the labia. The patient tolerated the procedure well. The patient was taken to the recovery room in stable condition.


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