Advancement of flap/U-shaped pedicle flap reconstruction of a left brow defect

PREOPERATIVE DIAGNOSES:

1.  Nodular basal cell carcinoma of the left forehead, left brow region.

2.  Acquired defect, left forehead brow region status post Mohs resection.  Defect measures 1.5 x 1 cm in size.

POSTOPERATIVE DIAGNOSIS:  

1.  Nodular basal cell carcinoma of the left forehead, left brow region.

2.  Acquired defect, left forehead brow region status post Mohs resection.  Defect measures 1.5 x 1 cm in size.

OPERATION PERFORMED:  Advancement of flap/U-shaped pedicle flap reconstruction of a left brow defect.

ANESTHESIA:  Local.

INDICATIONS:  The patient is 65-year-old female who was in her usual state of health without any acute medical problems who presents today for discussion regarding possible immediate reconstruction.  She desires immediate reconstruction after undergoing Mohs resection of a left brow defect.  I have taken care of her husband in the past.  In the preoperative setting, we discussed her findings as well as her options.  I gave realistic expectations of what to expect.  I discussed the potential complications including but not limited to bleeding, infection, and dehiscence of wound all of which may require further procedures of prolonged wound care.  In addition, I informed that despite best efforts, she indeed will have a permanent scar and only time will tell how significant that scar will be.  Potential complications _____ discussed, all questions answered, and she wishes that I proceed.  From my standpoint there were no medical contraindications to proceeding with primary reconstruction.

PROCEDURE IN DETAIL:  The patient was taken to the main operating room and placed supine on the operating room table.  The entire area was prepped and draped sterilely in the standard fashion.  Lidocaine 1% with epinephrine was used for local anesthesia.  Upon inspection of the wound, complex repair techniques would not result in satisfactory closure as it resulted in distortion of her left brow as well as bunching up of the tissue.  A U shaped pedicle flap was designed.  It was elevated after satisfactory anesthesia after incising the planned markings.  In this manner, the lateral component was advanced medially.  This resulted in no vertical pull.  Meticulous hemostasis was performed throughout using low-power needle tip cautery.  Irrigation carried out with saline solution.  Insetting in the flaps performed using interrupted 5-0 antibacterial Vicryl suture.  Skin it self was closed using running 5-0 fast absorbing suture.  This resulted in satisfactory closure with minimal distortion of the brow.  Mastisol and Steri-Strips were applied.  All sponge, instrument, and needle counts were correct x2