Debridement & plastic repair of nasal defect?

BFAITHFUL

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Doc wants to use CPT 15576 but Im not sure if it wouldn't just be 14060/14061??
Thanks!


DX: Nasal defect status post Mohs excision of basal cell carcinoma of nose
Procedure: Debridement and plastic repair of nasal defect using left nasolabial flap to nose.


Particular attention was paid to the left side of the nose in the lateral cartilage area, where a dfect from mohs excision of basal cell carcinoma one day prior was noted. The defect was measured and measured approximately 1.5 x 1.8cm and extended to a depth of appoximately 4mm. A skin marking pencil was used to outline a left nasolabial flap superiorly based to be used to rotate into fill the defect.
A template made out of foil was used to get the proper size and shape of the flap. This flap measured approximately 8 x 1.5cm. The patient's nose and left side of the face were then anesthetized through the use of injections of 1% Xylocaine with epinephrine local anesthetic solution. The defect was then debrided of charred tissue from electrocautery from the original surgery. This was done with scraping with a 15 scalpel blade until small punctate bleeding was noted. The defect extended down to the nasal cartilage, but not through the nasal cartilage. The flap was then created through the use of sharp dissection to a depth of approximately 4mm and elevated from distal to proximal to allow for proper rotation into the defect. Hemostasis was achieved through the use of electrocautery. The flap was rotated as designed and inset distally and on each side of the flap with interrupted suture of 5-0 chromic catgut subcutanteously and skin edges were approximated through the use of interrupted sutures of 6-0 nylon.
Attention was then directed to closure of the defect from the nasolabial flap in the left cheek. The skin edges were undermined in all directions through the use of sharp dissection at a depth of approx 3mm and hemostasis was achieved through the use electrocautery.
The flap was extended for a distance of approximately 1.5cm to allow for a fusiform end to be closed without skin puckering and wrinkling. This triangle was then excised through the use of sharp dissection again to a depth of approx 4mm. Skin edges were undermined in all directions, through the use of sharp dissection. Hemostasis was achieved through the use of electrocautery.
The donor siste was then repaired from inferior toward the superor base of the flap in layers with the subcutaneous tissues and dermis being approximated through the use of interrupted sutures of 4-0 chromic catgut and skin edges were approximated through the use of running sutures of 6-0 nylon. This left a triangular raw area at the base of the flap where the flap was rotated and it was elected to address this wound with a tie over dressing consisting of xeroform gauze and a moistened cotton ball; this was moistened with sterile saline and tie over cotton ball.
Attention was then directed to a dressing for the underside of the flap. In the raw areas, it was elected to suture a layer of xeroform gauze to help blood clotting in this area. This was done through the use iof interrupted sutures of 5-0 nylon with care being taken to make the sutures very small within the flap itself not to interfere with any blood supply. The blood supply of the flap remained good throughout with good color of the flap.
 
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