ebarker33
New
I could really use some help on this chart. Does the advancement flap include the advancement of the CARTILAGE? Or is there a separate code for the CARTILAGE part of this procedure?
THANK YOU IN ADVANCE for your help!!!
PREOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
POSTOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
OPERATION: Excision of basal cell carcinoma right helical rim with local tissue rearrangement Antia-Buck advancement flap 10 sq cm.
ANESTHESIA: Local.
ESTIMATED BLOOD LOSS: 10 mL.
COMPLICATIONS: None.
SPECIMENS: Frozen section: Initial positive margin at the 9 o'clock. Additional margin was excised and these were negative.
INDICATION FOR PROCEDURE: 71-year-old female who was seen my office, evaluated for lesion of the right helical rim. Shave biopsy turned out to be a basal cell carcinoma. The lesion measured around 1 cm in diameter. I offered the patient excision with closure. I explained to him the procedure in detail including the risks, benefits and complications including bleeding, infection and recurrence. He understood would like to proceed.
DETAILS OF OPERATION: After informed consent, he was brought to the operating room in stable supine position. The right side of the ear was prepped and draped in sterile fashion. I used 1% lidocaine with epinephrine and performed an ear block. I then used 1% lidocaine to perform the hydrodissection along the helical rim. I performed an excision of the lesion with a 3 mm margin. This was taken through the cartilage as well. The lesion was marked and sent for frozen section. It was positive at the 9 o'clock position. Additional tissue was excised. These were negative for pathology for basal cell.
I then proceeded to raise the anterior bulk flap. On the upper side of the helical rim I performed a V-Y advancement and on the lower side, we performed advancement and my incision was along the helix anteriorly extending all the way down to the lobule. I raised a skin and mucochondrial flap. I left the posterior wall intact. I performed elevation of the cartilage. The cartilage was then advanced and anchored with a 4-0 Monocryl. The tissues were advanced and then I closed, placed deep suture with interrupted 4-0 Monocryl and the skin was closed with 5-0 plain.
The patient tolerated the procedure well. He was taken to Recovery in stable condition.
THANK YOU IN ADVANCE for your help!!!
PREOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
POSTOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
OPERATION: Excision of basal cell carcinoma right helical rim with local tissue rearrangement Antia-Buck advancement flap 10 sq cm.
ANESTHESIA: Local.
ESTIMATED BLOOD LOSS: 10 mL.
COMPLICATIONS: None.
SPECIMENS: Frozen section: Initial positive margin at the 9 o'clock. Additional margin was excised and these were negative.
INDICATION FOR PROCEDURE: 71-year-old female who was seen my office, evaluated for lesion of the right helical rim. Shave biopsy turned out to be a basal cell carcinoma. The lesion measured around 1 cm in diameter. I offered the patient excision with closure. I explained to him the procedure in detail including the risks, benefits and complications including bleeding, infection and recurrence. He understood would like to proceed.
DETAILS OF OPERATION: After informed consent, he was brought to the operating room in stable supine position. The right side of the ear was prepped and draped in sterile fashion. I used 1% lidocaine with epinephrine and performed an ear block. I then used 1% lidocaine to perform the hydrodissection along the helical rim. I performed an excision of the lesion with a 3 mm margin. This was taken through the cartilage as well. The lesion was marked and sent for frozen section. It was positive at the 9 o'clock position. Additional tissue was excised. These were negative for pathology for basal cell.
I then proceeded to raise the anterior bulk flap. On the upper side of the helical rim I performed a V-Y advancement and on the lower side, we performed advancement and my incision was along the helix anteriorly extending all the way down to the lobule. I raised a skin and mucochondrial flap. I left the posterior wall intact. I performed elevation of the cartilage. The cartilage was then advanced and anchored with a 4-0 Monocryl. The tissues were advanced and then I closed, placed deep suture with interrupted 4-0 Monocryl and the skin was closed with 5-0 plain.
The patient tolerated the procedure well. He was taken to Recovery in stable condition.