renifejn
Guru
I haven't code Derm since I took the CPC exam years ago, but am now asked to review the following note. I cant remember if I need to take the largest size of the ellipse excision or if I need to multiply the dimensions of the ellipse together for each site? Thank you...
Postoperative Diagnoses: Congenital nevus of the posterior scalp
and congenital nevus of the right thigh.
Names of Operations/Procedures: Excision with complex closure on
the scalp, excision with intermediate closure on the thigh.
Anesthesia: General with 5 ml of 0.5% Xylocaine with epinephrine
and 4 ml of 0.25% Marcaine with epinephrine.
Operative Indications: These congenital nevi are being resected
to prevent deterioration into malignancy.
Description of Operative Procedure: After informed consent was
obtained and advised of the risks of
bleeding, infection, that scars will ensue at the site of removal
of these lesions, the patient was induced with general anesthesia
uneventfully. The area of the nevus was prepped and draped in the
usual manner on the scalp. The scalp nevus measured 16 x 16 mm,
the ellipse 29 x 17 mm. Specimen was excised to the galea and
submitted in its entirety for histopathologic exam. Hemostasis
was obtained using electrocautery. Blood loss was less than 10
ml. The wound edges were extensively undermined and the wound was
closed in two layers using 4-0 Vicryl interrupted subcutaneous
suture and 5-0 Prolene running cuticular suture. A standard
pressure dressing was placed over the area and attention was
turned to the right thigh, where a nevus measuring 9.6 mm was
present on the skin. A curved ellipse measuring 21 x 7 mm was
drawn around the nevus. It was excised into the fat and submitted
in its entirety for histopathologic exam. Hemostasis was
obtained using electrocautery and blood loss was less than 5 ml.
The wound edges were extensively undermined and the wound closed
in two layers using 4-0 Vicryl interrupted subcutaneous suture and
5-0 Prolene interrupted subcuticular suture. Steri-Strips and a
standard pressure dressing were placed over here. The patient was
discharged to recovery in good condition. Pt will return for
suture removal in two weeks.
Postoperative Diagnoses: Congenital nevus of the posterior scalp
and congenital nevus of the right thigh.
Names of Operations/Procedures: Excision with complex closure on
the scalp, excision with intermediate closure on the thigh.
Anesthesia: General with 5 ml of 0.5% Xylocaine with epinephrine
and 4 ml of 0.25% Marcaine with epinephrine.
Operative Indications: These congenital nevi are being resected
to prevent deterioration into malignancy.
Description of Operative Procedure: After informed consent was
obtained and advised of the risks of
bleeding, infection, that scars will ensue at the site of removal
of these lesions, the patient was induced with general anesthesia
uneventfully. The area of the nevus was prepped and draped in the
usual manner on the scalp. The scalp nevus measured 16 x 16 mm,
the ellipse 29 x 17 mm. Specimen was excised to the galea and
submitted in its entirety for histopathologic exam. Hemostasis
was obtained using electrocautery. Blood loss was less than 10
ml. The wound edges were extensively undermined and the wound was
closed in two layers using 4-0 Vicryl interrupted subcutaneous
suture and 5-0 Prolene running cuticular suture. A standard
pressure dressing was placed over the area and attention was
turned to the right thigh, where a nevus measuring 9.6 mm was
present on the skin. A curved ellipse measuring 21 x 7 mm was
drawn around the nevus. It was excised into the fat and submitted
in its entirety for histopathologic exam. Hemostasis was
obtained using electrocautery and blood loss was less than 5 ml.
The wound edges were extensively undermined and the wound closed
in two layers using 4-0 Vicryl interrupted subcutaneous suture and
5-0 Prolene interrupted subcuticular suture. Steri-Strips and a
standard pressure dressing were placed over here. The patient was
discharged to recovery in good condition. Pt will return for
suture removal in two weeks.
