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Jessica Gilliand 21996681 Penn Foster Medical Center Jeffery Thomas 10/29/2014 PREOPERATIVE DIAGNOSIS Basal cell carcinoma; of the right ear. POSTOPERATIVE DIAGNOSES Basal cell carcinoma; of the right ear. PROCEDURE PERFORMED Excision of basal cell carcinoma on the right ear; measuring 3.5 by 2 centimeters in length and width. A frozen section, as well as a full thickness of skin graft taken from the right supraclavicular region; for coverage measure 3.5 by 2 centimeters. ANESTHESIA MAC anesthesia INDICATIONS 79 year old male, who has a history of basal cell carcinoma, on the right posterior ear; which is treated with an excision, and skin graft; prior. Who has a lesion on the right mid helix which has been crusting, and ulcerating; and resembles another basal c ll carcinoma. PROCEDURE Patient is here today for a removal on their frozen section; sense there is no question as to whether the lesion is eroding on the deep service into the cartilage, as well as somequestion on the six a clock margin. Patient was brought into the operating room, placed upon the operating table. MAC anesthesia was administered by the anesthesiologist. The patient right ear, facial region, and neck region were prepped and draped in Thera surgical fashion.
The initial part of the procedure consisted of using one percent of lidocaine with one and one hundred thousand epinephrine creating an ear block around the patient's right ear. lidocaine was also injected into the conchal bowl for a total of 15 CC's for the right ear block in the conchal bowl block. After this was done and aloud to sit, the lesion was excised towards the lateral most portion of the helix towards the conchal bowl; using the 15 blade, removing the lesion from the paretondrium.
This was done circumferentially, and the lesion was then sent off for frozen pathology with the stitch in the twelve a clock position. The lesion encompassed the lateral medial helix, anti helix, and into the lateral most portion of the conchal bowl. The lesion measure 3.5 by 2 centimeters in length and width. The frozen specimen showed that the margins were all complete and circled Jeffery Thomas Jessica Gilliand 21996681 Penn Foster Medical Center 10/29/2014 Page 2partially into the deep margin. Hemostasis was maintained with the neo point electro corderin. An elliptical excision was made a pound the right lateral neck after infra treating with 1 percent lidocaine with one, and one hundred thousand epinephrine. This was made to set the measurements of the full thickness graft for 3.5 by 2 centimeters. This was taken down to the skin and into the subcutaneous tissue with the 15 blade.
The 15 was then used to dissect the full thickness skin graph off from the surrounding subcutaneous tissue. The wound was then closed using multiple interrupted buried foropedia sutures, and then a running subcuticular foroprolene stitch. Hemostasis was maintained prior to closer with the electro quarter. The full thickness skin graft was placed on a saline soaked lab pad during the closer of the right neck wound. The neck wound was also then cleansed; the sutures were applied.
The full thickness skin graph was then _____ using the metzenbaum scissors afterwards the full thickness skin graph was placed in the right ear defect and sutured circumferentially with long 4-0 silk stitches for a bolster. Some intermittent stitches were used with the 4-0 quillmate in between the bolster stitches. A 0 form was then applied over lining the full thickness skin graft.
A wet fluff was then applied and then the bolster was then tied tightly to the right ear. The right ear was then cleansed and multiple fluffs were places around the patient's right ear. Patient was then placed in a head dressing using a circumferential Curad and Ace bandage wrap. A Thera gauze wasplaced over the donor's side as well as McKesson tape. The patient tolerated the procedure well there were no complications during the procedure