DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Squamous cell carcinoma of the scalp.
POSTOPERATIVE DIAGNOSIS:
Squamous cell carcinoma of the scalp.
PROCEDURE PERFORMED: Excision of squamous cell carcinoma of the scalp with closure using Integra.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
ESTIMATED BLOOD LOSS: Minimal.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After obtaining informed consent, the patient was taken from the holding area to the operating room by the anesthesia and surgery teams. The patient was placed on the operating table in the supine position. After adequate general endotracheal anesthesia by the anesthesia team, the table was turned 90 degrees. Doughnut was placed below the patient’s scalp. The area around the lesion was shaved.
There were several lesions, two of which had seemed to erode into the bone and one lesion and particular bone was exposed. There were various stages of dysplasia and carcinoma in an approximately 10 x 10 cm area of the scalp. The area was then prepped and draped in the usual sterile fashion. A marking pen was used to mark an approximately 1 cm margin around any of these areas. There were 2 areas on the forehead that looked like seborrheic keratosis, which were elected to be dealt with at a later date given that they seemed to be seborrheic keratosis and not as critical at this point in addressing. It also seemed like resecting further onto the patient’s anterior scalp would cause some of the facial skin to sink over the brow and onto the mid face.
Therefore, an incision was made around the drawn line with cutting mode of a Bovie. Pericranium was left intact wherever possible, but when tumor was adjacent to this, the pericranium was elevated. The lesion in the skin was removed. It was labeled with a stitch at the anterior aspect that was long and a short stitch on the left side. It was sent for permanent specimen. The areas of bone that were involved were then addressed with a cutting bur. These were drilled down to the point where there was good punctate bleeding and no obvious diseased or marked even appearance to bone existed, and all around this region, the pericranium was elevated and sent also as a permanent specimen. After this was done, the area was copiously irrigated. There was still a significant bony layer, amounted to the outer calvarium, had been drilled down, and in 2 major areas, it was evolved with bone but it was not quite all the way to the diploe between the 2 calvarial layers. There was still an outer calvarial layer left. At this point, the case was taken over by the plastic surgery service.
Closure was performed with Integra, which was sewn in with a 4-0 chromic. Adaptic was then laid over this. Cotton was then laid over this to form a nice seal. Reston foam was then put over this with another layer of Adaptic on top of it. This was also stapled to the skin and kept in nice tight position. The patient was then allowed to awaken and was extubated without incident. She was returned to the recovery room in stable condition.
