KNP40806
Networker
Does anyone have any ideas about the following fascia grafting procedure. None of the codes that I have reviewed seem to fit.
PREOPERATIVE DIAGNOSIS: 4.2 cm malignancy right forehead.
POSTOPERATIVE DIAGNOSIS: 4.2 cm malignancy right forehead.
PROCEDURES: 1. Excision of same with full thickness graft from right neck.
2. Lateral advancement flap closure (to shrink defect).
3. Fascia graft to help provide depth under the graft.
SURGEON: Brian Wilson, M.D.
ANESTHESIA: Monitored anesthesia care.
Betadine prep was done of all these areas while the surgeon scrubbed, gowned, and gloved. A marking pen was used to mark around the lesions. Again #15 blade was used to excise the lesion. The lesion was sent for permanent pathology with a superior marking stitch. The entire forehead was undermined except for the inferior area near the eyebrow. The defect was shrunk laterally. An advancement flap was designed here using a 3-0 Vicryl in the deep layers and 4-0 plain in an interrupted fashion excising dog-ears where needed to shrink the defect. This was still a large defect. A large graft was harvested from the right neck (7 x 4 cm). Bovie cautery was used sparingly here in the neck. This area was closed with 3-0 Vicryl in the deep layers and 4-0 running, locking plane on the superficial layers. The graft was defatted and trimmed to fit the defect. There was a depth difference. Double hooks were used around the defect and fascia was harvested from the 15 mm circumference underneath the skin around the defect. This was placed over the central defect and then the graft was placed over this to provide a more symmetric depth under the graft. Then 4-0 plain was used to stitch the graft with the fascial graft underneath this. Bacitracin ointment was applied with Xeroform gauze with a pressure wrap around the forehead and the neck was dressed in a similar way. He tolerated the procedure well and left the operating room in stable condition.
PREOPERATIVE DIAGNOSIS: 4.2 cm malignancy right forehead.
POSTOPERATIVE DIAGNOSIS: 4.2 cm malignancy right forehead.
PROCEDURES: 1. Excision of same with full thickness graft from right neck.
2. Lateral advancement flap closure (to shrink defect).
3. Fascia graft to help provide depth under the graft.
SURGEON: Brian Wilson, M.D.
ANESTHESIA: Monitored anesthesia care.
Betadine prep was done of all these areas while the surgeon scrubbed, gowned, and gloved. A marking pen was used to mark around the lesions. Again #15 blade was used to excise the lesion. The lesion was sent for permanent pathology with a superior marking stitch. The entire forehead was undermined except for the inferior area near the eyebrow. The defect was shrunk laterally. An advancement flap was designed here using a 3-0 Vicryl in the deep layers and 4-0 plain in an interrupted fashion excising dog-ears where needed to shrink the defect. This was still a large defect. A large graft was harvested from the right neck (7 x 4 cm). Bovie cautery was used sparingly here in the neck. This area was closed with 3-0 Vicryl in the deep layers and 4-0 running, locking plane on the superficial layers. The graft was defatted and trimmed to fit the defect. There was a depth difference. Double hooks were used around the defect and fascia was harvested from the 15 mm circumference underneath the skin around the defect. This was placed over the central defect and then the graft was placed over this to provide a more symmetric depth under the graft. Then 4-0 plain was used to stitch the graft with the fascial graft underneath this. Bacitracin ointment was applied with Xeroform gauze with a pressure wrap around the forehead and the neck was dressed in a similar way. He tolerated the procedure well and left the operating room in stable condition.