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Hi, can anybody suggest, how to code pyogenic granuloma of hand. From 11400 series or from 26116 series. Granuloma was excised from the subcutaneous tissue.
Op note:- 2 cm hand mass.
Patient was identified in the preoperative area and the surgical site confirmed. The mass was confirmed. Surgical plan discussed. Surgical consent obtained. She was brought to the operating room and general anesthesia was induced. Preoperative antibiotics were given. A nonsterile tourniquet was placed but not inflated on the right upper arm. The right arm was cleansed with chlorhexidine, prepped with ChloraPrep and draped sterile. An ulnar-sided incision was designed directly over the mass including an ellipse of the biopsy tract which had not completed healing. We remained on the ulnar border of the small finger. A surgical timeout was performed. Gravity exsanguination and the tourniquet was inflated to 200 mmHg. We incised the skin including the ellipse of the prior biopsy tract. The tumor was immediately identified within the subcutaneous tissue. We elevated full-thickness skin flaps and distally we identified the ulnar digital neurovascular bundle in native tissue. We then traced this proximally deep to the mass and I performed a specific external neurolysis of the ulnar digital nerve to the small finger. The digital artery was visualized and intact as well. The mass was elevated off of the neurovascular bundle and we were able to elevate this off the deep tissue easily coming around the ulnar border of the hand. We then worked dorsally and elevated the dorsal skin including the small dorsal cutaneous nerve branch off of the mass and then remove the mass en bloc. This had well-defined borders and was lobulated. We examined the surgical bed and the neurovascular bundle was intact as well as the dorsal cutaneous nerve. We deflated the tourniquet at 25 minutes. We irrigated the wound and obtained hemostasis with bipolar electrocautery only. We then changed gloves and instruments and closed the wound with interrupted 4-0 Monocryl for the deep dermal layer and interrupted 4-0 nylon for the skin. The wound was dressed with Xeroform fluffs and Ace wrap. All fingers were well-perfused at the conclusion of the procedure.
Op note:- 2 cm hand mass.
Patient was identified in the preoperative area and the surgical site confirmed. The mass was confirmed. Surgical plan discussed. Surgical consent obtained. She was brought to the operating room and general anesthesia was induced. Preoperative antibiotics were given. A nonsterile tourniquet was placed but not inflated on the right upper arm. The right arm was cleansed with chlorhexidine, prepped with ChloraPrep and draped sterile. An ulnar-sided incision was designed directly over the mass including an ellipse of the biopsy tract which had not completed healing. We remained on the ulnar border of the small finger. A surgical timeout was performed. Gravity exsanguination and the tourniquet was inflated to 200 mmHg. We incised the skin including the ellipse of the prior biopsy tract. The tumor was immediately identified within the subcutaneous tissue. We elevated full-thickness skin flaps and distally we identified the ulnar digital neurovascular bundle in native tissue. We then traced this proximally deep to the mass and I performed a specific external neurolysis of the ulnar digital nerve to the small finger. The digital artery was visualized and intact as well. The mass was elevated off of the neurovascular bundle and we were able to elevate this off the deep tissue easily coming around the ulnar border of the hand. We then worked dorsally and elevated the dorsal skin including the small dorsal cutaneous nerve branch off of the mass and then remove the mass en bloc. This had well-defined borders and was lobulated. We examined the surgical bed and the neurovascular bundle was intact as well as the dorsal cutaneous nerve. We deflated the tourniquet at 25 minutes. We irrigated the wound and obtained hemostasis with bipolar electrocautery only. We then changed gloves and instruments and closed the wound with interrupted 4-0 Monocryl for the deep dermal layer and interrupted 4-0 nylon for the skin. The wound was dressed with Xeroform fluffs and Ace wrap. All fingers were well-perfused at the conclusion of the procedure.