Bernadette10
Guru
I was leaning toward 11423 and 12031, but the note says the incision was made to the mid subcutaneous fat. Does this mean the cyst was partially in the subcutaneous layer?
Diagnosis: pilar cyst
Location: scalp
Using sterile technique, a 15 blade, an elliptical incision was made to the mid subcutaneous fat. The lesion was removed and placed in formalin for pathologic diagnosis. Appropriate undermining was performed in order to decrease tension on the wound. Hemostasis was achieved.
A layered closure was performed in order to maintain hemostasis, decrease tension on the wound, approximate wound edges, and to improve the cosmetic appearance of the wound. Deep sutures x1 consisting of 4-0 maxon were placed in the subcutaneous tissues and dermis in a buried vertical mattress fashion. Superficially, 4-0 prolene were used to approximate the wound edges, using x3 simple interrupted sutures. Good hemostasis was obtained.
The lesion was rinsed and covered in mupirocin, and a pressure bandage was applied. Wound care instructions were reviewed with the patient. The patient will return in 14 days for suture removal.
Lesion size: 2.1 x 1.7 cm
Final length of closure: 1.5 cm
I was looking at this:
Subcutaneous tissue comprises an abundance of hair follicles and sweat glands. Moreover, there are many fibrous septa, similar to that of the palms of the hands and soles of the feet, closely connecting the skin and the galea aponeurotica layer. Therefore, subcutaneous fat is separated into small fat lobes by these fibrous septa. In this layer are many perforating arteries and veins heading to the skin from the main vascular network of the scalp inside the galea aponeurotica, along with the small sensory nerves transmitting cutaneous sensation.
Diagnosis: pilar cyst
Location: scalp
Using sterile technique, a 15 blade, an elliptical incision was made to the mid subcutaneous fat. The lesion was removed and placed in formalin for pathologic diagnosis. Appropriate undermining was performed in order to decrease tension on the wound. Hemostasis was achieved.
A layered closure was performed in order to maintain hemostasis, decrease tension on the wound, approximate wound edges, and to improve the cosmetic appearance of the wound. Deep sutures x1 consisting of 4-0 maxon were placed in the subcutaneous tissues and dermis in a buried vertical mattress fashion. Superficially, 4-0 prolene were used to approximate the wound edges, using x3 simple interrupted sutures. Good hemostasis was obtained.
The lesion was rinsed and covered in mupirocin, and a pressure bandage was applied. Wound care instructions were reviewed with the patient. The patient will return in 14 days for suture removal.
Lesion size: 2.1 x 1.7 cm
Final length of closure: 1.5 cm
I was looking at this:
Soft Tissue of the Scalp and Temporal Regions | Plastic Surgery Key
Introduction
The scalp is the soft tissue covering the calvaria. It anatomically positioned in the cranial side of the line connecting the supraorbital border of the forehead, the frontal process of the zygomatic bone, the superior margin of the zygomatic arch, the external acoustic foramen, the mastoid process of the temporal bone, and the superior nuchal line of the occipital bone.1 The major difference between the scalp and other skin in terms of appearance is that it has hair in almost all areas, excluding the forehead. In a cross-section, the scalp reveals a layered structure, usually divided into five layers, excluding the temporal region, as follows, from the outermost layer down: skin, subcutaneous fat (dense connective tissue), galea aponeurotica (aponeurotic layer), loose connective tissue; and pericranium (Fig. 4.1). Among these layers, the skin, subcutaneous tissue, and galea aponeurotica layer are closely connected, making it difficult to bluntly separate each layer. Therefore, these layers from the skin to galea aponeurotica are lumped together and also called the superficial fascial layer, whereas loose connective tissue is also called the deep fascial layer.2Scalp (Skin) and Subcutaneous Fat Layer
The structure of the scalp is fundamentally similar to the skin in other regions; however, the dermis is thick compared with that in other parts of the body and is rich in blood vessels. Furthermore, it has an abundance of hair.Subcutaneous tissue comprises an abundance of hair follicles and sweat glands. Moreover, there are many fibrous septa, similar to that of the palms of the hands and soles of the feet, closely connecting the skin and the galea aponeurotica layer. Therefore, subcutaneous fat is separated into small fat lobes by these fibrous septa. In this layer are many perforating arteries and veins heading to the skin from the main vascular network of the scalp inside the galea aponeurotica, along with the small sensory nerves transmitting cutaneous sensation.
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