Question 37 (1 point) Excision of a sacral pressure ulcer

Question 37 (1 point) Excision of a sacral pressure ulcer with primary suture Question 37 options: A) 15934 B) 15940 C) 15931 D) 15950 Question 38 (1 point) Saved To report an excision of a malignant lesion, the correct range of codes to use would be: Question 38 options: A) 11600-11646 B) 11400-11471 C) 11200-11201 D) 11100-11101 Question 39 (1 point) Removal of 37 skin tags by electrosurgical destruction: Question 39 options: A) 11200, 11201 x 3 B) 11201 x 4 C) 11200 x 4 D) none of the above Question 40 (1 point) Breast reconstruction with free flap Question 40 options: A) 19369 B) 19364 C) 19366 D) 19367 Question 41 (1 point) Full-thickness graft, free, to the axillae, including direct closure of donor site, 12 sq. cm. Question 41 options: A) 15240 B) 15200 C) 15260 D) 15261 Question 42 (1 point) Suction lipectomy, lower right leg. Question 42 options: Question 43 (1 point) Suture of superficial wounds of cheek: one 1-cm laceration, one 3-cm laceration, and one 2-cm laceration. Question 43 options: Question 44 (1 point) Excision of benign lesion on chest, 0.4 cm (including margins), with simple closure. Question 44 options: Question 45 (1 point) Removal, implantable contraceptive capsules Question 45 options: Question 46 (1 point) Mastopexy Question 46 options: Question 47 (2 points) The patient is brought back to the operating room, for a staged procedure to a procedure that was performed 5 days previously. DIAGNOSIS: Status post open wound, right lower extremity. SURGICAL PROCEDURE: Split thickness skin graft, right thigh to right lower extremity. DESCRIPTION OF PROCEDURE: The patient’s right leg was prepped with Betadine scrub and solution and draped in the routine sterile fashion. A skin graft was taken from the right thigh on its anterolateral aspect, meshed with a 1:1.5 ratio mesher, and applied to the 66 sq. cm defect on the right leg with staples. Dressing consisted of Xeroform, Kerlix fluffs, Kerlix roll, Kling, Sof-Rol, and a short leg fiberglass cast. Scarlet Red and ABD pads were applied to the donor site. The patient tolerated the procedure well and left the area in good condition. Pathology Report Later Indicated: Benign tissue Question 47 options: Question 48 (2 points) INDICATIONS: The patient had a YV advancement flap and advancement of the hamstring muscles about 3 weeks ago, but the wound separated and the muscles retracted over the area of the bone. She has had moderate separation of the wound but not complete separation, and we plan to minimally debride this area and resuture the wound with tension sutures. DIAGNOSIS: Wound dehiscence, left ischial area, partial. SURGICAL FINDINGS: A 6 cm long by about 4 cm deep wound dehiscence. PROCEDURE PERFORMED: Debridement of ischial wound by curettage with secondary wound closure. PROCEDURE: The patient was intubated and turned in the prone position. The area was prepped with Betadine scrub and solution and draped in routine sterile fashion. The area was curettaged and a piece of the tissue was placed in a culture tube. This was curettaged down to bleeding granulation tissue. I was reluctant to restart by complete debridement of all these areas, because there are factors operative in this wound that are probably beyond our control. We nevertheless completed debridement of the granulation down to bleeding tissue and put far/near, near/far tension type sutures in the wound using #2 Ethibond. I then put some Xeroform underneath the sutures that were holding the wound together and put three boxes of Kerlix Fluffs on top of this to cover some of the open areas on the thigh. The thigh sutures were also removed. I then taped the three boxes of Kerlix Fluffs to the ischial area with Elastoplast and taped around the leg to hold this in place, placing an ABD pad over the open areas where the sutures had been present. I then taped the buttock and leg up on the lumbar area with Elastoplast in such a manner as to support the ischial closure. A home health care nurse was in attendance at this time and she was advised as to how to retape and dress this on a daily basis. The patient had two open areas of the thigh and right lower leg, one of which was a donor site, the other of which was an old skin graft with open areas. We applied Scarlet Red and ABD pads to this area. Estimated blood loss 50 cc. Otherwise, the patient tolerated the procedure well and left the area in good condition. Question 48 options: Question 49 (1 point) PREOPERATIVE DIAGNOSIS: Pilonidal cyst. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Excision of pilonidal cyst, simple. ANESTHESIA: General endotracheal anesthesia with 30 cc of local infiltrated directly into the wound. PROCEDURE IN DETAIL: After good general endotracheal anesthesia, the patient was carefully placed in the prone position. Care was taken to pad dependent areas. The area around the pilonidal cyst was shaved, prepped, and draped sterilely. After this, a total of 30 cc of Marcaine was injected into the area around the pilonidal sinus and a small elliptical incision was made to include the two sinuses. Wide dissection was carried down to the coccyx to include all inflamed tissue. After this, the wound was irrigated. Hemostasis was obtained with electrocautery. The wound was packed with Vaseline gauze and dressed. The patient tolerated the procedure well and was returned to the recovery room in good condition. Question 49 options: Question 50 (1 point) Escharotomy, initial incision Question 50 options: Submit Quiz

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