awest
Networker
Should I use a rhinoplasty code for this case? It was scheduled as complex repair...Thanks!
OPERATIVE NOTE
PREOPERATIVE DIAGNOSES: Status post Mohs resection of BCCA of nose, planned third stage reconstruction.
POSTOPERATIVE DIAGNOSES: Status post Mohs resection of BCCA of nose, planned third stage reconstruction.
PROCEDURES: Complex repair with local advancement of the nasal supratip area reconstruction.
ANESTHESIA: General laryngeal mask.
INDICATIONS: The patient is a 74-year-old white male who is status post reconstruction of the paramedian forehead flap who had a second stage, who now plans for the third definitive stage to debulk the tip reconstruction. The patient was explained the risks, benefits, indications, and potential complications, which included but not limited to bleeding, infection, scarring, recurrence, and need for additional treatment, and the patient wished to proceed.
FINDINGS: Valve reconstructed dorsum with fullness to the supratip regions and lateral supratip regions, especially on the right side for debulking.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. He underwent general laryngeal mask anesthesia. The patient was prepped, draped, and marked in a routine sterile fashion. After this was done, where the flap was inset at the supratip area all the way circumferentially, this was freed up and then undermined, wide undermining performed and debulked to the fatty tissue underneath the supratip region and into the tip region, especially in the lateral supratip to create the alar concavities bilaterally. Once this was done, some of the excess skin at the junction was excised and some of the fat that was removed was placed onto the dorsum just at the junction of the advanced mid nose skin to the supratip region to prevent further postoperative depression in that area. Once this was done, 6-0 nylons were used circumferentially to close the area in the supratip and lateral supratip regions. This nicely created the alar concavity by debulking that area and also reconstructing the supratip junction.