Any suggestions on coding this procedure. I am just not sure
Operation: 1. Lateral canthal reconstruction.
2. Intermarginal adhesion.
3. Full-thickness skin graft from right upper lid to right lower lid.
4. Frost suture tarsorrhaphy.
Pt has severe ectropion secondary to right lower lid laxity as well as previous cancers removed from his right lower lid that resulted in severe ectropion.
The upper lid was injected. A standard upper lid belpharoplasty incision was then marked. Skin was then removed. Hemostasis was maintained. The incision line was closed with a 6-0 nylon. Next a canthotomy cantholysis was performed, releasing the inferior canthal tendon completely. A tarsal strip was then fashioned with removal of the orbicularis anteriorly as well as the posterior conjunctiva posteriorly. A subciliary incision was then peprformed with release of anterior lamell including down the orbicularis. Hemostatis was maintained. The graft was then transfered over from the right upper lid to the right lower lid, set in position with a 6-0 fast. A 5-0 Vicryl on a P2 needle was then used to resuspend the lower lid tarsal plate. When that was satisfactory, then a 5-0 fast was used to create an intermarginal adhesion and the skin graft, as I said, was sewn into place with a 6-0 fast. At the conclusion a Frost suture tarsorrhaphy was placed on the lid.
Thanks
Charla
Operation: 1. Lateral canthal reconstruction.
2. Intermarginal adhesion.
3. Full-thickness skin graft from right upper lid to right lower lid.
4. Frost suture tarsorrhaphy.
Pt has severe ectropion secondary to right lower lid laxity as well as previous cancers removed from his right lower lid that resulted in severe ectropion.
The upper lid was injected. A standard upper lid belpharoplasty incision was then marked. Skin was then removed. Hemostasis was maintained. The incision line was closed with a 6-0 nylon. Next a canthotomy cantholysis was performed, releasing the inferior canthal tendon completely. A tarsal strip was then fashioned with removal of the orbicularis anteriorly as well as the posterior conjunctiva posteriorly. A subciliary incision was then peprformed with release of anterior lamell including down the orbicularis. Hemostatis was maintained. The graft was then transfered over from the right upper lid to the right lower lid, set in position with a 6-0 fast. A 5-0 Vicryl on a P2 needle was then used to resuspend the lower lid tarsal plate. When that was satisfactory, then a 5-0 fast was used to create an intermarginal adhesion and the skin graft, as I said, was sewn into place with a 6-0 fast. At the conclusion a Frost suture tarsorrhaphy was placed on the lid.
Thanks
Charla