BFAITHFUL
Expert
Need help with the following report.......doc wants to use 30400-52 not sure though between 30400 vs 30410?
DX: Laceration of left upper lateral cartilage of nose with scar tissue.
Operation Open rhinoplasty with excision of scar tissue and repair of laceration of left upper lateral cartilage.
A skin marking pen was used to outline a stair step incision across narrow portion of the nasal columella and also outlined was a mass on the left side of the nose measuring approximately 4x5mm just inferior to the nasal bone area. The nasal bones were also outline with dotted lines. The nasal vibrissae were then cleansed with a betadine solution and trimmed short with a steven scissors. The nasal vestibules was again cleansed with betadine solution. The fascial area was prepped with diluted betadine solution and draped in a sterile fashion. The nasal area was then anesthetized throughthe use of injections of 1% xylocaine withepinephrine local anesthetic solution and an appropriatewaiting period was observed to aid ina dequate hemostatis. Attention was initially directed to creation of the stair step incision through the use of sharp dissection. This was then connected to bilateral rim incisions and through the use of sharp dissection the nasal columellar flap was elevated. The nasal alar cartilages were separated from the overlying soft tissues through the use of blunt dissection with a scissors. This was extended across the mid portion of the nose to elevate the soft tissue from the nasal cartilage through the use of sharp dissection. this was then connected to the undermining of the columellar flap.
The nasal dorsum was then separated from the underlying soft tissues through the use of sharp and blunt dissection. Attention was directed to the left side of the nose directly under the area and marked out on the skin.. Some scar tissue was encountered during the dissection and was separated in a subcutaneous plane from the underlying tissues. The scar tissue was removed through the use of sharp dissection and measured approx. 4 x 5mm. Underlying this was a laceration of the left upper lateral cartilage in a vertical direction with the lateral portion of cartilage turned back and elevated causing the palpable flap. This was then sutured down in to its original position using interrupted sutures of 6-0 nylon which resulted in good contour internally and externally. The flap was replaced in its original position and following the achievement of adequate hemostasis through the use of electrcautery, the flap was repaired. 6-0 nylon for the columellar skin and interrupted sutures of 5-0 chromic catgut to the nasal mucosa.
Thanks!
DX: Laceration of left upper lateral cartilage of nose with scar tissue.
Operation Open rhinoplasty with excision of scar tissue and repair of laceration of left upper lateral cartilage.
A skin marking pen was used to outline a stair step incision across narrow portion of the nasal columella and also outlined was a mass on the left side of the nose measuring approximately 4x5mm just inferior to the nasal bone area. The nasal bones were also outline with dotted lines. The nasal vibrissae were then cleansed with a betadine solution and trimmed short with a steven scissors. The nasal vestibules was again cleansed with betadine solution. The fascial area was prepped with diluted betadine solution and draped in a sterile fashion. The nasal area was then anesthetized throughthe use of injections of 1% xylocaine withepinephrine local anesthetic solution and an appropriatewaiting period was observed to aid ina dequate hemostatis. Attention was initially directed to creation of the stair step incision through the use of sharp dissection. This was then connected to bilateral rim incisions and through the use of sharp dissection the nasal columellar flap was elevated. The nasal alar cartilages were separated from the overlying soft tissues through the use of blunt dissection with a scissors. This was extended across the mid portion of the nose to elevate the soft tissue from the nasal cartilage through the use of sharp dissection. this was then connected to the undermining of the columellar flap.
The nasal dorsum was then separated from the underlying soft tissues through the use of sharp and blunt dissection. Attention was directed to the left side of the nose directly under the area and marked out on the skin.. Some scar tissue was encountered during the dissection and was separated in a subcutaneous plane from the underlying tissues. The scar tissue was removed through the use of sharp dissection and measured approx. 4 x 5mm. Underlying this was a laceration of the left upper lateral cartilage in a vertical direction with the lateral portion of cartilage turned back and elevated causing the palpable flap. This was then sutured down in to its original position using interrupted sutures of 6-0 nylon which resulted in good contour internally and externally. The flap was replaced in its original position and following the achievement of adequate hemostasis through the use of electrcautery, the flap was repaired. 6-0 nylon for the columellar skin and interrupted sutures of 5-0 chromic catgut to the nasal mucosa.
Thanks!