Need some help list on this one I have
14301
14301x9??
11622
This one has me confused and I am looking for some feedback please
M,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Biopsy-proven SCCA of the left parietal scalp (two separate but adjacent lesions).
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURE PERFORMED:
1. Wide local excision SCCA left parietal scalp. Total lesion plus margin dimensions 6cm.
2. Closure, scalp flap with radial galeal scoring, 35 X 10 cm.
3. Excision suspicious lesion scalp (anterior Burrowes triangle extended to iclude this lesion) lesion + margin dimension 2 X 1 cm
SURGEON:
ANESTHESIA:
GET
ANESTHESIOLOGIST:
EBL:
Minimal.
IVF'S:
1100 cc LR
COMPLICATIONS:
None.
DRAINS:
TLS X 2
LOCAL:
60 mL of 1/4% Marcaine with 1:100,000 epinephrine.
SPECIMENS:
Wide local excision the biopsy proven SCCA of the left parietal scalp with short
suture superior and long suture lateral.
Two burrow triangles, anterior and posterior, both labeled short suture tip long suture lateral edge. The anterior had a suspicious lesion at the tip.
ANTIBIOTICS:
Ancef 2 gms IVPB prior to incision.
DVT PROPHYLAXIS:
TEDS and SCDs to bilateral LE, engage prior to induction of anesthesia. Lovenox in pre opa rea secondary to history of Factor V Leiden Deficiency
FINDINGS:
None.
SUMMARY:
xxxxxx was first seen in the preoperative area,
where the area in question, left parietal scalp, was identified and agreed upon as the area of resection. By this, preop verification was confirmed. Informed consent was then signed, obtained, and witnessed. The skin cancer of the left parietal scalp was examined. The visible margin of the lesion marked and an additional 5mm added
around it to form a total lesion plus margin dimension of 6cm in a oval shape.
This was then shaped into an ellipse in the Langerhans lines of 10 cm for linear closure. The area was then infiltrated with 60 cc 1% lidocaine with 1:200,000 epinephrine. She was prepped and draped in usual sterile manner.
I incised through the skin to subcutaneous tissue and controlled bleeding with
Cautery. I placed a short suture at superior tip of the ellipse and a long
suture to the lateral edge of the ellipse. I continued dissection with
cautery down to the galea. The edges were able to be dissected at this level, but the central aspects of both lesions te subcutaneous and galea levels were fused and the dissection was taken to calvarium by necessity. The cortical defect was roughly 5 X 3 cm. The lesion was removed it at this level.
It was passed off the table for specimen. The wound was irrigated and hemostasis obtained with cautery. A moist sponge was placed in the defect.
The frozen section pathology returned with all Margins free of tumor.
Closure than began. In order to acheive this the scalp was undermined in the plane between the scalp and the galea from the left ear to the right ear. The total undermined area was 35 X 10 cm. In order to gain more movement from each of the flaps the scalp flaps were scored transecting the galea in several parallel lines in the sagital direction on the left side and with cross hatching as well on the right side. The flaps were than advance to close the defect. It was closed with deep buried 3-0 Vicryl sutures in an interrupted fashion at the galea/deep dermal level. The incision was cleansed with NS and covered Antibiotic ointment.
All needle and sponge counts were reported equal at the end of the case. Patient
tolerated the procedure without any difficulty. No untoward side effects
were noted. They were transferred from the OR to the PACU awake, extubated and in stable condition.
PATH :
BRIEF CLINICAL HISTORY
1 - biopsy proven SCCA, two adjacent lesions, parietal scalp, 2 ?
burrows triangle, anterior scalp, 3 - burrows triangle posterior scalp.
GROSS:
Specimen #1 labeled biopsy proven SCCA two adjacent lesions, parietal
scalp short - superior, long - lateral is a 5.0 x 2.9 x 0.3 cm ovoid
excision of tan skin with a 1.0 x 0.9 cm eccentric tan-brown lesion and
a 1.5 cm tan-pink eccentric lesion. There is a short suture designated
12 o'clock and a long suture designated 9 o'clock. Ink code: 12-3
o'clock - blue, 3-6 o'clock - green, 6-9 o'clock - orange, 9-12 o'clock
- yellow. Sectioned and entirely submitted in: 1AFS - superior
lesion, 1BFS - inferior lesion, 1C-1D - remainder of the superior
lateral lesion, 1E - medial section, 1F-1I - rest of inferior lesion.
FROZEN SECTIION DX: Squamous cell carcinoma x2, all margins free.
(COC)
SA/bah/COC
Specimen #2 labeled Burow's triangle anterior scalp, short ? superior,
long ? lateral, suspicious lesion at the tip is a 3.0 x 1.7 x 0.1 cm
triangular ellipse of tan skin with a short suture designated superior
and a long suture designated lateral. There is a 0.5 cm tan-pink
ulcerated area near the superior suture. Ink code: lateral ? yellow,
medial ? blue. Serially sectioned and entirely submitted in 2A-2E.
Specimen #3 labeled Burow's triangle posterior scalp, short suture ?
posterior tip, long suture ? lateral is a 2.4 x 1.8 x 0.1 cm triangular
ellipse of tan skin with two sutures, the short suture designated
posterior scalp and the long suture designated lateral. Ink code:
lateral ? yellow, medial ? blue. Serially sectioned and entirely
submitted in 3A-3D.
SA/bah/COC
MICROSCOPIC DIAGNOSIS:
Skin, parietal scalp, excision: Two separate foci of Residual
Moderately Differentiated
Squamous Cell Carcinoma surrounded by marked biopsy related changes and
scarring. Adjacent skin with actinic keratosis. Inked margins free of
malignancy.
Burow's triangle anterior scalp, excision: Skin with Squamous Cell
Carcinoma in-Situ (Bowen's disease) in a background of severely
dysplastic actinic keratosis, margins narrowly free. Closest lateral
near the tip.
Burow's triangle posterior scalp, excision: Benign skin with actinic
change.
14301
14301x9??
11622
This one has me confused and I am looking for some feedback please
M,CCS,CPC
PREOPERATIVE DIAGNOSIS:
Biopsy-proven SCCA of the left parietal scalp (two separate but adjacent lesions).
POSTOPERATIVE DIAGNOSIS:
Same
PROCEDURE PERFORMED:
1. Wide local excision SCCA left parietal scalp. Total lesion plus margin dimensions 6cm.
2. Closure, scalp flap with radial galeal scoring, 35 X 10 cm.
3. Excision suspicious lesion scalp (anterior Burrowes triangle extended to iclude this lesion) lesion + margin dimension 2 X 1 cm
SURGEON:
ANESTHESIA:
GET
ANESTHESIOLOGIST:
EBL:
Minimal.
IVF'S:
1100 cc LR
COMPLICATIONS:
None.
DRAINS:
TLS X 2
LOCAL:
60 mL of 1/4% Marcaine with 1:100,000 epinephrine.
SPECIMENS:
Wide local excision the biopsy proven SCCA of the left parietal scalp with short
suture superior and long suture lateral.
Two burrow triangles, anterior and posterior, both labeled short suture tip long suture lateral edge. The anterior had a suspicious lesion at the tip.
ANTIBIOTICS:
Ancef 2 gms IVPB prior to incision.
DVT PROPHYLAXIS:
TEDS and SCDs to bilateral LE, engage prior to induction of anesthesia. Lovenox in pre opa rea secondary to history of Factor V Leiden Deficiency
FINDINGS:
None.
SUMMARY:
xxxxxx was first seen in the preoperative area,
where the area in question, left parietal scalp, was identified and agreed upon as the area of resection. By this, preop verification was confirmed. Informed consent was then signed, obtained, and witnessed. The skin cancer of the left parietal scalp was examined. The visible margin of the lesion marked and an additional 5mm added
around it to form a total lesion plus margin dimension of 6cm in a oval shape.
This was then shaped into an ellipse in the Langerhans lines of 10 cm for linear closure. The area was then infiltrated with 60 cc 1% lidocaine with 1:200,000 epinephrine. She was prepped and draped in usual sterile manner.
I incised through the skin to subcutaneous tissue and controlled bleeding with
Cautery. I placed a short suture at superior tip of the ellipse and a long
suture to the lateral edge of the ellipse. I continued dissection with
cautery down to the galea. The edges were able to be dissected at this level, but the central aspects of both lesions te subcutaneous and galea levels were fused and the dissection was taken to calvarium by necessity. The cortical defect was roughly 5 X 3 cm. The lesion was removed it at this level.
It was passed off the table for specimen. The wound was irrigated and hemostasis obtained with cautery. A moist sponge was placed in the defect.
The frozen section pathology returned with all Margins free of tumor.
Closure than began. In order to acheive this the scalp was undermined in the plane between the scalp and the galea from the left ear to the right ear. The total undermined area was 35 X 10 cm. In order to gain more movement from each of the flaps the scalp flaps were scored transecting the galea in several parallel lines in the sagital direction on the left side and with cross hatching as well on the right side. The flaps were than advance to close the defect. It was closed with deep buried 3-0 Vicryl sutures in an interrupted fashion at the galea/deep dermal level. The incision was cleansed with NS and covered Antibiotic ointment.
All needle and sponge counts were reported equal at the end of the case. Patient
tolerated the procedure without any difficulty. No untoward side effects
were noted. They were transferred from the OR to the PACU awake, extubated and in stable condition.
PATH :
BRIEF CLINICAL HISTORY
1 - biopsy proven SCCA, two adjacent lesions, parietal scalp, 2 ?
burrows triangle, anterior scalp, 3 - burrows triangle posterior scalp.
GROSS:
Specimen #1 labeled biopsy proven SCCA two adjacent lesions, parietal
scalp short - superior, long - lateral is a 5.0 x 2.9 x 0.3 cm ovoid
excision of tan skin with a 1.0 x 0.9 cm eccentric tan-brown lesion and
a 1.5 cm tan-pink eccentric lesion. There is a short suture designated
12 o'clock and a long suture designated 9 o'clock. Ink code: 12-3
o'clock - blue, 3-6 o'clock - green, 6-9 o'clock - orange, 9-12 o'clock
- yellow. Sectioned and entirely submitted in: 1AFS - superior
lesion, 1BFS - inferior lesion, 1C-1D - remainder of the superior
lateral lesion, 1E - medial section, 1F-1I - rest of inferior lesion.
FROZEN SECTIION DX: Squamous cell carcinoma x2, all margins free.
(COC)
SA/bah/COC
Specimen #2 labeled Burow's triangle anterior scalp, short ? superior,
long ? lateral, suspicious lesion at the tip is a 3.0 x 1.7 x 0.1 cm
triangular ellipse of tan skin with a short suture designated superior
and a long suture designated lateral. There is a 0.5 cm tan-pink
ulcerated area near the superior suture. Ink code: lateral ? yellow,
medial ? blue. Serially sectioned and entirely submitted in 2A-2E.
Specimen #3 labeled Burow's triangle posterior scalp, short suture ?
posterior tip, long suture ? lateral is a 2.4 x 1.8 x 0.1 cm triangular
ellipse of tan skin with two sutures, the short suture designated
posterior scalp and the long suture designated lateral. Ink code:
lateral ? yellow, medial ? blue. Serially sectioned and entirely
submitted in 3A-3D.
SA/bah/COC
MICROSCOPIC DIAGNOSIS:
Skin, parietal scalp, excision: Two separate foci of Residual
Moderately Differentiated
Squamous Cell Carcinoma surrounded by marked biopsy related changes and
scarring. Adjacent skin with actinic keratosis. Inked margins free of
malignancy.
Burow's triangle anterior scalp, excision: Skin with Squamous Cell
Carcinoma in-Situ (Bowen's disease) in a background of severely
dysplastic actinic keratosis, margins narrowly free. Closest lateral
near the tip.
Burow's triangle posterior scalp, excision: Benign skin with actinic
change.
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