DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Acquired defect of nose, status post Mohs excision of basal cell cancer.
POSTOPERATIVE DIAGNOSIS: Acquired defect of nose, status post Mohs excision of basal cell cancer.
OPERATION PERFORMED: Bilobed myocutaneous local flap reconstruction.
ANESTHESIA: MAC with local 1% lidocaine with epinephrine and 0.5% Marcaine 1:1, 10 mL total.
SURGEON: John Doe, MD
SPECIMENS: Skin from nose around Mohs defect.
ESTIMATED BLOOD LOSS: Minimal.
DISPOSITION: Stable to same day surgery.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old Hispanic male who presents with a defect approximately 1.4 cm in greatest diameter on the dorsolateral tip of his nose. The defect is not full thickness. There is intact cartilage underneath of the wound. Assessment was done preoperatively, and the determination of a local bilobed flap would be appropriate. The patient was consented for the procedure and understands the risks and benefits of the procedure, which includes scarring, bleeding, and infection.
DESCRIPTION OF OPERATION: After explaining potential risks and benefits of the procedure to the patient, written consent was obtained. The patient was taken to the operating room by gurney and transferred to the operating room table in a supine position. Monitored anesthesia care was initiated and 1 g of Ancef was given preoperatively. Once the patient was under MAC, 10 mL of the above listed local anesthetic were infused over the dorsum and the lateral aspects of the nose to hydrodissect a plane off the perichondrium and bony vault. The face was then prepped with Betadine paint and draped in a standard sterile fashion. A time-out was performed to indicate the patient, procedure, and site to be operated on.
First, we began by marking out the proposed flap. This was laterally based on the right side and bilobed in nature, containing both the muscle and skin and subcutaneous layers. After this was done, it was incised with a 15 blade and then the entire dorsal and lateral aspects of the nose were degloved off of the periosteum and perichondrium.
With this mobile skin, we then rotated the bilobed flap into position, and the donor site was closed primarily with 4-0 PDS sutures deep and 6-0 nylon running suture superficially. The flap was inset into the defect, which had been previously trimmed and a small Burow’s triangle was removed and sent for pathology. It was secured into place likewise with 4-0 PDS suture deep and 6-0 nylon interrupted suture superficially.
Prior to closure, hemostasis was achieved with electrocautery and pressure. The patient tolerated the procedure well without any immediate complications. A layer of bacitracin and sterile gauze was placed over the incision. The patient tolerated the procedure well.
