The Doc coded with a 14300
I kind of disagree on that...I was told by another source to use a 69399...I would love to hear more feed back on this one!
PREOPERATIVE DIAGNOSIS: Large, acquired defect, left ear, secondary to Mohs surgery and failed reconstruction times two.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE:
CLINICAL HISTORY: This 70-year-old male previously underwent Mohs surgery on the left ear for basal cell carcinoma. Apparently, the dermatologist performed a local flap, which failed, and then a skin graft, which also failed. The patient was referred. At the time of referral, he had a large defect measuring 25x30 mm, involving both the anterior ear from the scapha triangular fossa across the helical rim, and onto the posterior pinna surface.
OPERATIVE PROCEDURE & FINDINGS: After satisfactory LMA, the patient's ear was prepped with Technicare and draped in a sterile fashion. A periauricular block was accomplished, and some local infiltration into the skin edges.
The wound was débrided of necrotic tissue, and unfortunately, a large portion of the helical rim cartilage and scapha cartilage was absent. Following debridement, the defect measured approximately 20 mm anterior surface, and 20 mm on the posterior surface, with approximately 20 mm of helical rim and cartilage missing. It was elected to perform a wedge resection with reconstruction of the superior and inferior portions of the ear. Accordingly, an incision was carried into the concha floor and across the antihelical folding cartilage. Following wedge resection of the remaining areas of the defect, the skin was undermined posteriorly and anteriorly for several millimeters beyond the cartilage edge. The cartilage was then reconstructed with figure-of-eight 5-0 Maxon sutures, carefully aligning the helical rim area. Because of the bulge at the antihelical fold, because of the discrepancies in the thicknesses of the tissue, a triangular wedge of skin and cartilage was resected on the medial edge of the antihelical fold, into the concha floor cartilage. The cartilage also was approximated with 5-0 Maxon suture. Following good approximation and equalization of the cartilage repair, the anterior skin was then repaired with 5-0 nylon, as was the helical rim. Posteriorly, the skin was approximated also with 5-0 nylon. This produced an incision extending from the concha floor, across the anterior ear, across the helical rim, and onto the posterior ear, nearly to the sulcus. Adaptic gauze, without antibiotic ointment, and cotton dressings, were then applied and fixed with Hypafix tape.
The patient tolerated the procedure quite well. The ear looked slightly smaller, but maintained a normal contour.
Thanks!!
I kind of disagree on that...I was told by another source to use a 69399...I would love to hear more feed back on this one!PREOPERATIVE DIAGNOSIS: Large, acquired defect, left ear, secondary to Mohs surgery and failed reconstruction times two.
POSTOPERATIVE DIAGNOSIS: Same.
PROCEDURE:
- Excision and debridement of necrotic tissue, left ear, with primary bilateral chondrocutaneous flap reconstruction.
- Wedge resection of conchal cartilage and skin.
CLINICAL HISTORY: This 70-year-old male previously underwent Mohs surgery on the left ear for basal cell carcinoma. Apparently, the dermatologist performed a local flap, which failed, and then a skin graft, which also failed. The patient was referred. At the time of referral, he had a large defect measuring 25x30 mm, involving both the anterior ear from the scapha triangular fossa across the helical rim, and onto the posterior pinna surface.
OPERATIVE PROCEDURE & FINDINGS: After satisfactory LMA, the patient's ear was prepped with Technicare and draped in a sterile fashion. A periauricular block was accomplished, and some local infiltration into the skin edges.
The wound was débrided of necrotic tissue, and unfortunately, a large portion of the helical rim cartilage and scapha cartilage was absent. Following debridement, the defect measured approximately 20 mm anterior surface, and 20 mm on the posterior surface, with approximately 20 mm of helical rim and cartilage missing. It was elected to perform a wedge resection with reconstruction of the superior and inferior portions of the ear. Accordingly, an incision was carried into the concha floor and across the antihelical folding cartilage. Following wedge resection of the remaining areas of the defect, the skin was undermined posteriorly and anteriorly for several millimeters beyond the cartilage edge. The cartilage was then reconstructed with figure-of-eight 5-0 Maxon sutures, carefully aligning the helical rim area. Because of the bulge at the antihelical fold, because of the discrepancies in the thicknesses of the tissue, a triangular wedge of skin and cartilage was resected on the medial edge of the antihelical fold, into the concha floor cartilage. The cartilage also was approximated with 5-0 Maxon suture. Following good approximation and equalization of the cartilage repair, the anterior skin was then repaired with 5-0 nylon, as was the helical rim. Posteriorly, the skin was approximated also with 5-0 nylon. This produced an incision extending from the concha floor, across the anterior ear, across the helical rim, and onto the posterior ear, nearly to the sulcus. Adaptic gauze, without antibiotic ointment, and cotton dressings, were then applied and fixed with Hypafix tape.
The patient tolerated the procedure quite well. The ear looked slightly smaller, but maintained a normal contour.
Thanks!!