Wedge resection. 40490 Biopsy of lip 40510 Excision of lip; transverse wedge excision with primary closure 40520 Excision of lip; V-excision with primary direct linear closure 40525 Excision of lip; full thickness, reconstruction with local flap (e.g., Estlander or fan) A single, more obtuse wedge may suffice; however, tension would be greatest at the point of wedge closure, leaving curled and redundant tissue on either side of the wedge. This results in labial remnants that are quite short and no longer have the natural edge architecture (Fig. The keys to success include knowing the anatomy of these structures, careful marking of lines of incision, stopping bleeding and the meticulous realignment of skin surfaces. Double folds are usually excised in a linear edge resection resulting in a scar in the interlabial groove. 6.38a Heart-shaped wedge excision from the lower lip (up to one-third). Fig. Defects between 1/3 to 2/3 of the lip can be reconstructed in two stages using an Abbe Estlander Flap. A patient presents with a 2cm benign lip lesion. 98.6 D. Leukoplakia vermilionectomy. This 63-year-old white male had recurrent thickening and scaling of the lower lip for two years. The physician used a mucosal graft from the wedge excised from the lip with reconstruction of the vermillion of the right upper lip. The author presents a patient with the upper lip SCC treated by wedge surgical excision. The extended wedge procedure described by Alter6 addresses the widened clitoral hood through a superior extension of the wedge onto the lateral clitoral hood (Fig. • The removal of excess labia minora with a wedge technique spares critical nerves and preserves arterial supply. Fig. Left: Right upper lip defect (~1/3). Fig. What CPT code is reported for this? Indications and Contraindications Findings: Myomucosal lip island flap can effectively treat defects from 1 to 2.8 cm extending deeply into the lip with excellent cosmetic results. The lip is very elastic, 1/3 of the lip can be wedged out without obvious deformity. 4-2 A, Labia minora wedge resection markings. B. Wedge Excision. • Complications such as edge notching, dehiscence, and hematoma are rare (see Chapter 10: Complications of Female Cosmetic Genital Surgery). 4-9 This 37-year-old patient had redundant labia minora in the sagittal plane. Log In or, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Labial Reduction: Surgical Wedge Technique, Chapter 10: Complications of Female Cosmetic Genital Surgery, allows adjustment of the amount of submucosa resection, facilitating the removal of full-thickness submucosa in patients with very bulky labia. Left: Near midline small upper lip defect. 4-6 and. Single layer suture repair is performed. 2011 Apr 14. . Orthopaedics Power Coding in the ER and OR On-Demand, KarenZupko & Associates, Inc. © 2021 | All Rights Reserved, New 2021 Evaluation and Management Code Guidelines, Documenting Family History for New Patient Visits, Carotid Artery Exploration with Free Flap to Oral Cavity. Fig. 4-11 A and B, This 46-year-old woman had a funnel variant. The best cosmetic results are obtained when the orbicularis oris muscle and vermilion border are carefully repaired. 40490 Biopsy of lip 40510 Excision of lip; transverse wedge excision with primary closure 40520 Excision of lip; V-excision with primary direct linear closure 40525 Excision of lip; full thickness, reconstruction with local flap (e.g., Estlander or fan) The lesion and surrounding tissues are removed. Radial Elongation of the Labia Minora Some authors have claimed that a wedge excision of the paralysed lower lip (with or without suspension of the orbicularis oris muscle) would remove a considerable part of the “denervated” non-functional musculature and so improve the symmetry and function of the lip. Patients with large labia minora may have a widened or redundant clitoral hood. You should use CPT code 40525 when the physician removes a full thickness portion of the lip with local flap reconstruction. Fig. 6.47). An average of 3.75 cm (41.7%; range, 20 to 70%) of horizontal lip length was excised. This reduces the length and thus the ruffling and bulkiness to provide a more aesthetic result (Fig. It can be performed under local anesthesia. A 44-year-old member asked: how much does lung wedge resection hurt? Fig. Fig. This lady was very anxious about keeping a fullhead of hair. Edge trim procedures in these patients may result in a persistence of hood laxity and redundancy and the appearance of a “penis” postoperatively4 (Fig. In 1998 Alter2 first described the wedge technique as a central wedge removed from the most protuberant portion of the labia minora. 4-10). This Corner lip lift diagram illustrates the "Wedge Excision" used during the procedure. Patients with minimal submucosa are also well suited for wedge resection. This flap takes a portion of the intact lip (equal 4-12). The advantages included preservation of the natural edge architecture, a shorter scar, and decreased scar sensitivity. Vermilionectomy (40500 Vermilionectomy (lip shave), with mucosal advancement) is the shaving or excision of the vermilion border of the lip. Funnel Variant The slight tension created by a wedge resection tends to reduce the anterior projection of the clitoral hood, preventing redundancy and the penis appearance. In 1998 Alter2 first described the wedge technique as a central wedge removed from the most protuberant portion of the labia minora. Wedge resection of the lower lip. The web should be released, similar to a small episiotomy, at the time of labiaplasty. Only gold members can continue reading. I was looking at 14060 but not sure if that would be correct or enough. The technical modification narrowed the clitoral hood and minimized the dog-ear created with the wedge-only technique. Risk of distortion of Cupid's bow increases as the excision nears the midline and as the width of the wedge increases. Many patients have additional folds of the labia minora superiorly. Findings: Myomucosal lip island flap can effectively treat defects from 1 to 2.8 cm extending deeply into the lip with excellent cosmetic results. … This scar tends to be more painful postoperatively because of its location on the perineum. Case 6. 4-4 This 27-year-old woman has unilateral labia minora hypertrophy (submucosal thickening). F, Surgical incisions for segmental pattern (FN). In 2008 Alter3 reviewed his 2-year experience with 407 extended wedge labiaplasties. • Labiaplasty by wedge reduction is a safe and effective procedure. 40510. The fold begins at the confluence of the clitoral frenulum and the labia minora and extends superiorly for a variable distance toward the intervulvar commissure (Fig. In performing a wedge resection, noting the position of the posterior lip is essential. The basics of wedge resection of the lower lip are reviewed. Send thanks to the doctor. Surgical excision with negative margins is the mainstay of treatment for lip SCC. Squamous cell carcinoma to the ear and lip requiring wedge excision. Was a pinwheel flap for a BCC on the vertex of the scalp. A coapting suture is placed at the skin-vermilion border (A). CHAPTER 4 4-13). Very thin, atrophic labia with little submucosa are not amenable to wedge resection, because submucosal sutures tend to tear through, resulting in edge notching and/or fenestrations (Fig. Many patients have additional folds of the labia minora superiorly. 4-12 This 50-year-old woman has a double-fold variant. 4-3 and Figs. Pre Op Cystic BCC. This code also includes the repair of the excisional area by mucosal advancement. • The use of low-temperature plasma radiofrequency cautery may help in wound healing and early recovery. 4-10 This 32-year-old woman with thin labia minora has fenestrations 8 weeks after a wedge labiaplasty. The lung is first deflated by in injecting air into the space bet ... Read More. Paint the margins with ink according to your laboratory protocol. Wedge . This protocol includes resection of tumours of the lip. It involves a full thickness wedge of tissue being removed and repaired with sutures to restore a normal appearance. Wedge resection. This scar tends to be more painful postoperatively because of its location on the perineum. 98.6 B. removing a V-shaped piece of tissue with the apex pointing towards the labial edge, from the most prominent part of the labium The physician will perform an onychectomy in which the nail along the edge that is growing into the skin is cut away and the offending piece of nail is pulled out.Any infection is surgically drained. Fig. Using a hand mirror, surgeons should point out the posterior labial redundancy preoperatively and describe the additional scarring that will result. Wedge techniques are best suited for patients with radial elongation of the labia and continuous edge pigmentation (Fig. 4-5 This 46-year-old woman is shown 10 months after having an edge resection labiaplasty. Fig. Wedge excision of lips and ears Aust Fam Physician. 4-2). Related 4-4). 4-2). Edge trim procedures in these patients may result in a persistence of hood laxity and redundancy and the appearance of a “penis” postoperatively4 (Fig. Lip resection Background. C and D, She is shown after having an extended wedge labiaplasty and posterior lip release. Multilayer wedge-shaped excisions can be performed on the lower and upper lip, on the auricle and on the lower eyelid. This procedure allows full thickness removal of the paralyzed side of the lower lip, resulting in centralization of the lip tubercle and symmetry at rest. Hunter5 stated that hood redundancy was the most common reason for revision labiaplasty surgery. A triangular wedge is drawn out … A triangular wedge is drawn out in a vertical fashion starting 5 mm from the oral commissure. 4-12 This 50-year-old woman has a double-fold variant. Dr. Stephen Siegel answered. Cancers of the lower lip are most common and most often caused by sun exposure. Psychological Issues and Social Mores in Female Genital Aesthetic Surgery: What Is Normal. VAT: Video aided thoracoscopy (vat) has greatly minimized pain in lung wedge resection. The use of an intraoral mental nerve block greatly decreases the pain for the patient. • Complications such as edge notching, dehiscence, and hematoma are rare (see Chapter 10: Complications of Female Cosmetic Genital Surgery). 4-9). Wedge excision is reserved for the eye-lids, lips and ears. Surgical gem: island advancement flaps for lip reconstruction. 1991 Mar;20(3):297-301. 4-5). Larger defects can be reconstructed with bilateral inferiorly based melolabial flaps. The first report of a wedge excision of ali~. • Wedge resection creates a small horizontal scar that is nearly imperceptible once healed. Lopiccolo MC, Kouba DJ. 4-5). 4-10 This 32-year-old woman with thin labia minora has fenestrations 8 weeks after a wedge labiaplasty. Right: Burow wedge excision with primary closure (A-to-T flap). Patients with tumor excision with involvement of margin, traumatic lip defects closed primarily were excluded.
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