DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Nasal bridge laceration.
POSTOPERATIVE DIAGNOSIS: Nasal bridge laceration.
OPERATION PERFORMED: Repair of laceration to nasal bridge area.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient was placed supine on the ER gurney. Then, 1% Xylocaine with epinephrine was locally infiltrated into the wound area. The wound was irrigated. Betadine prep was used. A blue towel was used to create a sterile field. Magnifying loupes were used throughout the surgery.
A purple marking pen was used to draw a lenticular-shaped excision margin around the main vertically oriented laceration. However, on the left side, there was a tongue of tissue, which crossed over to the right side, and this was not marked for excision. The remainder of the wound was marked and excised. The deep tissues were then approximated using interrupted 5-0 Vicryl sutures. Externally, the wound was closed beginning superiorly and traveling inferiorly. The wound was closed using interrupted 5-0 nylon sutures. As the area with the tongue of avulsed tissue was approached, we felt that it would be better to close the avulsion area at a linear scar, creating a three-pronged laceration, all with linear arms versus insetting the avulsed tissue and having ended up with a hockey stick-shaped scar.
Therefore, the avulsed tissue on the left side of the wound was sharply debrided completing the lenticular-shaped excision of the main vertical axis of the wound. Where the tissue was avulsed from, on the right side of the wound, was then undermined with a scalpel to allow the dermis and epidermis to advance and meet in a linear wound. This linear wound was closed using interrupted 6-0 nylon sutures. The remainder of the vertical wound was then closed using interrupted 5-0 nylon sutures.
Because of the forces and the nature of the debridement, the vertically oriented main wound had a slight curve in it, once all the sutures were placed. This could not be avoided. Also, a small dog ear was created inferiorly when the closure was complete. There was no undue tension on final closure. The skin remained viable with good capillary refill.
All the eroded, feathered, and traumatized edges were removed prior to final closure. Betadine prep was clean. Bacitracin ointment was placed in the suture line. The final length of the wound was superiorly 13 mm, inferiorly 4.5 mm, and the horizontal component measured 8.5 mm. There were no complications. The patient tolerated the procedure well. The patient was instructed on the signs and symptoms of infection and asked to call or return immediately if these were to occur.
