Closure 14060 x2


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The Op Report Reads: First portion of the proc involved refreshing all of the preoperative markings. Next 1% lidocaine with epinephrine was used for a small field block. Next an incision was made using a 15 blade along the rt alar crease & extended medially towards the rt philtral column & laterally around the curvature of the ala. This was extended down into the subcutaneous tissues above the orbicularis oris muscle. Next a similar incision was created along the white roll/vermilion border on the medial aspect of the defect & extended laterally to the rt oral commissure. This was also kept above the level of the orbicularis muscle. The flaps wre then elevated above the orbicularis oris muscle, laterally to the oral commissure, and medially to the philtral column. They were advanced towards the center of the defect. Any additional tissue that was trimmed was sent for final pathology given the the pt's history of basal cell carcinoma. Care was taken not to over-advance the medial segment & obliterate the contour of the philtral column. Burrows triangles were removed from the lateral segment of the advancement flap at the corner of the oral commissure. The flaps were then sutured in place using 4-0 moncryl interrupted sutures to suturethe deep dermis down to the orbicularis temporarily, then 4-0 monocryl deep dermal sutures were use to bring together the lower portion of the dermis & a 6-0 prolene was use for the cutaneour portion of the lip and alar crease in an interrupted an running fashion. Lastly, the 6-0 prolene was used to reapproximate the advancement along the vermillion border in a running technique. All of the wounds were cleaned, dried, and a sterile dressing was applied once symmetry and tension-free closure was confirmed. The pt was awakened......
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