DLT
Guest
I just started coding plastic surgery and I was wondering if someone can confirm that I have coded this correctly and didnt miss anything, thank you in advance for your help and suggestions. Below is the op notes:
Flap Closure of nose defect
Right nasal defect measured over 2cm in greatest diameter and was down to perchondrium over the right ala an dupper lateral cartilages. The defect extended to 5mm from the nostril edge. The wound was copiously irrigated and sharply debrided of necrotic tissue at the level of the skin, subcutaneous tissue and underlying nasal muscel (11043) so that bleeding tissue was apprechiated. A 0.5cm posterior portion of the defect was widely undermined and closed primarily using 4.0 vicryl deep dermals and 5.0 nylon sutures (13510). A superiouly based rotation-advancement flap measuring 2.5x4.5cm at the supraperichondreal level carrying nasalis muscle was raised from the lateral nasal side wall and tissue lateral to the medial canthus and rotated into the defect (14041). It was tacked wth 4.0 vicryl sutures.
A second advancement of cheek tissue was then widely undermined and a 4x3cm flap advanced to close the nasal sidewall/cheek defect (14061). To allow for advancement, a wedge of skin was excised from the nasolabial fold region. The flap was tacked to the periosteum of the nasal bone using 2.0 vicryl to prevent lateral pull on the tissue. Hemostasis was achieved and the wound copiously irrigated prior to final closure using 4.0 vicryl deep dermals and 5.0 nylon sutures.
Prior to closure, both flaps had health red bleeding from the skin edge.
11043
14061
14041
13150
Thank you,
DLT
Flap Closure of nose defect
Right nasal defect measured over 2cm in greatest diameter and was down to perchondrium over the right ala an dupper lateral cartilages. The defect extended to 5mm from the nostril edge. The wound was copiously irrigated and sharply debrided of necrotic tissue at the level of the skin, subcutaneous tissue and underlying nasal muscel (11043) so that bleeding tissue was apprechiated. A 0.5cm posterior portion of the defect was widely undermined and closed primarily using 4.0 vicryl deep dermals and 5.0 nylon sutures (13510). A superiouly based rotation-advancement flap measuring 2.5x4.5cm at the supraperichondreal level carrying nasalis muscle was raised from the lateral nasal side wall and tissue lateral to the medial canthus and rotated into the defect (14041). It was tacked wth 4.0 vicryl sutures.
A second advancement of cheek tissue was then widely undermined and a 4x3cm flap advanced to close the nasal sidewall/cheek defect (14061). To allow for advancement, a wedge of skin was excised from the nasolabial fold region. The flap was tacked to the periosteum of the nasal bone using 2.0 vicryl to prevent lateral pull on the tissue. Hemostasis was achieved and the wound copiously irrigated prior to final closure using 4.0 vicryl deep dermals and 5.0 nylon sutures.
Prior to closure, both flaps had health red bleeding from the skin edge.
11043
14061
14041
13150
Thank you,
DLT
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