I could really use some input on this surgery. Is the excision of the cartilage included in the excision of the BCCA of the helical rim? Any CPT guidance would be greatly appreciated. Thank you!
PREOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
POSTOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
OPERATION: Excision of basal cell carcinoma right helical rim with local tissue rearrangement Antia-Buck advancement flap 10 sq cm.
ANESTHESIA: Local.
ESTIMATED BLOOD LOSS: 10 mL.
COMPLICATIONS: None.
SPECIMENS: Frozen section: Initial positive margin at the 9 o'clock. Additional margin was excised and these were negative.
INDICATION FOR PROCEDURE: 71-year-old female who was seen my office, evaluated for lesion of the right helical rim. Shave biopsy turned out to be a basal cell carcinoma. The lesion measured around 1 cm in diameter. I offered the patient excision with closure. I explained to him the procedure in detail including the risks, benefits and complications including bleeding, infection and recurrence. He understood would like to proceed.
DETAILS OF OPERATION: After informed consent, he was brought to the operating room in stable supine position. The right side of the ear was prepped and draped in sterile fashion. I used 1% lidocaine with epinephrine and performed an ear block. I then used 1% lidocaine to perform the hydrodissection along the helical rim. I performed an excision of the lesion with a 3 mm margin. This was taken through the cartilage as well. The lesion was marked and sent for frozen section. It was positive at the 9 o'clock position. Additional tissue was excised. These were negative for pathology for basal cell.
I then proceeded to raise the anterior bulk flap. On the upper side of the helical rim I performed a V-Y advancement and on the lower side, we performed advancement and my incision was along the helix anteriorly extending all the way down to the lobule. I raised a skin and mucochondrial flap. I left the posterior wall intact. I performed elevation of the cartilage. The cartilage was then advanced and anchored with a 4-0 Monocryl. The tissues were advanced and then I closed, placed deep suture with interrupted 4-0 Monocryl and the skin was closed with 5-0 plain.
The patient tolerated the procedure well. He was taken to Recovery in stable condition.
PREOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
POSTOPERATIVE DIAGNOSIS: Basal cell carcinoma right helical rim.
OPERATION: Excision of basal cell carcinoma right helical rim with local tissue rearrangement Antia-Buck advancement flap 10 sq cm.
ANESTHESIA: Local.
ESTIMATED BLOOD LOSS: 10 mL.
COMPLICATIONS: None.
SPECIMENS: Frozen section: Initial positive margin at the 9 o'clock. Additional margin was excised and these were negative.
INDICATION FOR PROCEDURE: 71-year-old female who was seen my office, evaluated for lesion of the right helical rim. Shave biopsy turned out to be a basal cell carcinoma. The lesion measured around 1 cm in diameter. I offered the patient excision with closure. I explained to him the procedure in detail including the risks, benefits and complications including bleeding, infection and recurrence. He understood would like to proceed.
DETAILS OF OPERATION: After informed consent, he was brought to the operating room in stable supine position. The right side of the ear was prepped and draped in sterile fashion. I used 1% lidocaine with epinephrine and performed an ear block. I then used 1% lidocaine to perform the hydrodissection along the helical rim. I performed an excision of the lesion with a 3 mm margin. This was taken through the cartilage as well. The lesion was marked and sent for frozen section. It was positive at the 9 o'clock position. Additional tissue was excised. These were negative for pathology for basal cell.
I then proceeded to raise the anterior bulk flap. On the upper side of the helical rim I performed a V-Y advancement and on the lower side, we performed advancement and my incision was along the helix anteriorly extending all the way down to the lobule. I raised a skin and mucochondrial flap. I left the posterior wall intact. I performed elevation of the cartilage. The cartilage was then advanced and anchored with a 4-0 Monocryl. The tissues were advanced and then I closed, placed deep suture with interrupted 4-0 Monocryl and the skin was closed with 5-0 plain.
The patient tolerated the procedure well. He was taken to Recovery in stable condition.
