# groin exploration help



## lindacoder (Feb 17, 2015)

not sure what to use for the groin exploration.  I can use 38790 for mapping of the lymphocele.

PREOPERATIVE DIAGNOSIS:  Right groin lymphocele status post right fem distal  bypass with vein graft

POSTOPERATIVE DIAGNOSIS:  Same.

PROCEDURE:  Right groin wound exploration with isosulfan blue administration  for lymphatic mapping, ligation of lymphatic vessels, Tisseel application and  Praveena wound VAC placement.

ANESTHESIA:  General.

SPECIMENS:   
1.  Right groin fluid on a culture swab to microbiology. 2.  Right groin hematoma to microbiology.

ESTIMATED BLOOD LOSS:  Minimal.

FINDINGS:   
1.  A small hematoma to the right groin site.
2.  Isosulfan blue administration with identification of small lymphatic  vessels with mild extravasation of blue dye into the right groin site.  3.  Excellent pulsatility of the vein bypass graft.

INDICATIONS FOR PROCEDURE:  The patient is a 53-year-old gentleman who  underwent a right fem to anterior tibial bypass vein graft.  He had had a  prior groin exposure for right femoral to infrageniculate popliteal artery  bypass in the past.  He had extensive scarring to the right groin site.  Postoperatively, he developed a lymphocele and then subsequent lymphocutaneous  fistula. Given this fact, intervention was indicated.  The risks, benefits,  and alternatives of procedure were discussed with the patient, informed  consent was obtained.

DESCRIPTION OF THE PROCEDURE:  The patient was taken to the operating room  theater.  He was placed in supine position.  General anesthesia was induced.  Preoperative antibiotics were administered.  The patient's right groin and leg  were then prepped and draped in normal sterile fashion.   

4 mL of isosulfan blue dye were injected subdermally to the right thigh.  This  was then massaged and 5 minutes allow for this to traverse the lymphatic  vessels.  The staples were then removed from the right groin site.  The Vicryl  sutures were removed as well.  There was a moderate lymphocele cavity  identified without a fibrous capsule as this was in the early postoperative  period.  Once the wound was opened, evaluation for blue dye was sought.  He  did have at the inferior aspect of the wound, evidence of blue dye to the  lymphatics with only mild extravasation at this point. These lymphatic  branches were identified and controlled with Hemoclips.  There was a large  lymphatic vessel lateral to the wound and this was ligated with a Hemoclip as  well.  The wound was then monitored and there was found to be no further  extravasation of fluid or blue dye.  There was a small hematoma within the  wound site.  This was sent for microbiology.  The fluid was cultured with a  culture swab and was sent as well.  There was excellent pulsatility in the  vein graft.   

The groin was then closed in 3 separate layers with a #1 Vicryl suture.  Tisseel with 2 separate vials was then applied between each layer of the  closure.  The edges of the skin were then excised to freshen the skin margins  as the lateral aspect was macerated from the fluid drainage.  The skin was  then closed loosely with staples.  The Pravena wound VAC was then applied over  the staple line and held an excellent seal.

The patient tolerated the procedure well.  There were no complications.  All  counts were correct as reported to me at the end of the case.

Any thoughts???

Thanks


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