CKindred
Contributor
Please Help!!! 
Procedure: A right latissiumus flap denervation with excision, thoracodorsal nerve: a right implant exchange: a right symmastria repair with Alloderm
Description of procedure: The patient was placed on the OR table in supine position. After induction of general anesthesia, the chest was prepped and draped in usual fashion. Initially, the lateral aspect of the mastectomy scar was excised beneath the right axilla. Exploration performed with identification of the lateral borders of the latissimus flap and the rotation point of the lattissimus flap in the axilla and then the thoracodorsal pedicle was identified in that area. A nerve stimulator was used and a 2-mA stiimulus confirmed the thoracodorsal nerve, which was then dissected over a 3-cm area, clipped and divided resecting the 3 cm length of the thoracodorsal nerve. That wound was then closed in layers with a combination of 3-0 PDS and 3-0 and 4-0 Monocryl. The medial aspect of the latissimus skin paddle scars was opened. Cautery dissection carried through the underlying subcutaneous tissue, muscle, and capsule. The implant was removed, which was a 500 mL Mento high-profile implant. The medial pocket evaluated and a capsulotomy performed on the anterior segment of the breast several centimeters from the area of excess pocket dissection, so a neosubpectoral pocket was dissected in that location and the capsule tacked back to the chest wall. With the laxity still o f the skin in that area, some additional suturing of that part of the pocket to the chest wall of the overlying flap was performed with an 0 Ethibond suture, and then within the area of the capsulotomy, a 6- x 16-cm AlloDerm was initially pie crusted and the sutured around 10- to 12-cm length of the medial pocket around 4 cm width. Interrupted 3-0 PDS was used for that tacking of the AlloDerm. A sizer was then placed with a 475 mL Allergan Style 410 FF sizer that was evaluated with the patient upright and then compared to a 425 mL Style 410 FF sizer with 410 overall having the best slope of the upper pole and a reasonable volume match, so that sizer was removed. The pocket irrigated with triple antibiotic solution. Gloves were changed. A 19-French JP drain was placed though an inferior stab incision up the medial gutter of the breast and then the 425 mL Style 410 FF implant was placed, followed by muscle and capsule closure with 3-0 Monocryl and then layered skin closure with 3-0 and 4-0 Monocryl. Dermabond and ABD dressings were applied along with a breast binder garment. Blood loss 25 mL. The patient was taken to recovery room stable.
I have the implant exchange and alloderm codes, I just don't know the code for the denervation.
Thanks in advance.
Procedure: A right latissiumus flap denervation with excision, thoracodorsal nerve: a right implant exchange: a right symmastria repair with Alloderm
Description of procedure: The patient was placed on the OR table in supine position. After induction of general anesthesia, the chest was prepped and draped in usual fashion. Initially, the lateral aspect of the mastectomy scar was excised beneath the right axilla. Exploration performed with identification of the lateral borders of the latissimus flap and the rotation point of the lattissimus flap in the axilla and then the thoracodorsal pedicle was identified in that area. A nerve stimulator was used and a 2-mA stiimulus confirmed the thoracodorsal nerve, which was then dissected over a 3-cm area, clipped and divided resecting the 3 cm length of the thoracodorsal nerve. That wound was then closed in layers with a combination of 3-0 PDS and 3-0 and 4-0 Monocryl. The medial aspect of the latissimus skin paddle scars was opened. Cautery dissection carried through the underlying subcutaneous tissue, muscle, and capsule. The implant was removed, which was a 500 mL Mento high-profile implant. The medial pocket evaluated and a capsulotomy performed on the anterior segment of the breast several centimeters from the area of excess pocket dissection, so a neosubpectoral pocket was dissected in that location and the capsule tacked back to the chest wall. With the laxity still o f the skin in that area, some additional suturing of that part of the pocket to the chest wall of the overlying flap was performed with an 0 Ethibond suture, and then within the area of the capsulotomy, a 6- x 16-cm AlloDerm was initially pie crusted and the sutured around 10- to 12-cm length of the medial pocket around 4 cm width. Interrupted 3-0 PDS was used for that tacking of the AlloDerm. A sizer was then placed with a 475 mL Allergan Style 410 FF sizer that was evaluated with the patient upright and then compared to a 425 mL Style 410 FF sizer with 410 overall having the best slope of the upper pole and a reasonable volume match, so that sizer was removed. The pocket irrigated with triple antibiotic solution. Gloves were changed. A 19-French JP drain was placed though an inferior stab incision up the medial gutter of the breast and then the 425 mL Style 410 FF implant was placed, followed by muscle and capsule closure with 3-0 Monocryl and then layered skin closure with 3-0 and 4-0 Monocryl. Dermabond and ABD dressings were applied along with a breast binder garment. Blood loss 25 mL. The patient was taken to recovery room stable.
I have the implant exchange and alloderm codes, I just don't know the code for the denervation.
Thanks in advance.