DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Acquired defect, left nose and cheek, from Mohs procedure.
2. Basal cell carcinoma, left nose and cheek.
POSTOPERATIVE DIAGNOSES:
1. Acquired defect, left nose and cheek, from Mohs procedure.
2. Basal cell carcinoma, left nose and cheek.
PROCEDURES PERFORMED:
1. Local cheek advancement and full-thickness skin graft measuring 1 x 2 cm.
2. Infraorbital nerve block.
SURGEON: John Doe, MD
ANESTHESIA: Local 20 mL of 1:1 mix 0.5% Marcaine plain and 1% lidocaine with epinephrine.
SPECIMENS: None.
COMPLICATIONS: None immediate.
INDICATIONS FOR PROCEDURE: The patient is an (XX)-year-old Hispanic female with basal cell carcinoma of her nose. This was excised by Dr. Jane Doe with the Mohs technique. The patient presents today, 24 hours out from her excision for closure. After observing the patient and examining the tissues, it was determined that left cheek advancement in the medial fashion would be of benefit and closing the defect, which initially measured 2 x 2.5 cm. We then would need a full-thickness skin graft to close the remainder of the defect. The patient was consented for the procedure and understands the risks and benefits of the procedure, including potential graft failure, hematoma, and scarring.
DESCRIPTION OF OPERATION: The patient was consented for the procedure preoperatively, taken to the operating room by gurney, and transferred to the operating table in the supine position. The above-listed local anesthetic, 20 mL, was infused in and around the acquired defect, and an infraorbital nerve block was placed with the above-listed local anesthetic. We then took a preauricular full-thickness skin graft and infused this area with the same anesthetic mix.
Next, a time-out was performed confirming the patient, procedure, and site to be operated on. The defect was cleaned and sharply debrided of any necrotic tissue. We then dissected in a subcutaneous plane over the cheek in the lateral direction. This undermining mobilized the left cheek skin, and we were able to advance this toward the midline approximately 1 cm. A small dog ear was excised around the base of the nasal ala. We then closed some of the wound primarily in a layered fashion with 4-0 PDS suture and 6-0 nylon suture.
The full-thickness skin graft measuring 1 x 2 cm was harvested, and the donor site was closed in a layered fashion with 4-0 PDS deep and running 6-0 nylon superficially. The skin graft was thinned of any subcutaneous fat. It was then placed into the defect and secured into place with 5-0 nylon tie-over sutures. Bacitracin and Adaptic, mineral oil soaked gauze, and a half inch Reston foam bolster were then fashioned over the skin graft, and it was tied into place with the 5-0 nylon tie-over bolsters. The patient tolerated the procedure well without any immediate complications.
