# Removal of stitch granuloma



## bethh05

*Post Op*: Stitch granuloma of the abdominal wall x7

*Procedures*: 1. Removal of foreign bodies, x7 of the abdominal wall.
                 2. Debridement of skin granulomas of the abdominal wall.
                 3. Scar revision of the abdominal wall. 

*Description*: 
Once adequate level of sedation was obtained, the patient's abdomen was sterilely prepped and draped in a routine fashion with Betadine. His ileostomy was covered with Ioban. The granulomas in the midline were identified. The skin and subcutaneous tissue around these were infiltrated locally with lidocaine 1% with epinephrine. An elliptical incision was made around these granulomas to include the scar that was present there. This was carried down into the  subcutaneous tissue with electrocautery. This segment of skin to include these granulomas was then excised in its entirety. There were five sutures of blue, thick, and stiff sutures, which apeared to be Prolene present and were extruding through these granuloma sites. Each of the sutures were grasped, cut and removed in their entirety, and irrigated with saline solution. The subcutaneous tissue was approximated utilizing a 3-0 Vicryl in an interrupted fashion. The skin edges were approximated utilizing 3-0 nylon in an interrupted fashion and alternating simple interrupted sutures with vertical mattress sutures. I then proceeded with the suture granuloma on the left lower quadrant. An incision was made over it after first anesthetizing the skin and subcutaneous tissue with lidocaine 1% with epinephrine. The stitch was identified. Once again, stiff blue stitch, which appeared to be Prolene. It was excised and removed. The wound was then irrigated with a saline solution. The skin was then reapproximated with 3-0 nylon interrupted fashion. I then proceeded with the granuloma on the right lower quadrant, which was opened with a scalpel after first anesthetizing the skin and subcutaneous tissue with lidocaine 1% with epinephrine. The stitch on the skin was identified, which appeared to be a Prolene stitch as well. It was excised in its entirety. The wound was irrigated with saline solution. The skin edges were approximated with 3-0 nylon in an interrupted fashion. Sterile dressing was then applied. The patient was then transferred to the recovery room in satisfactory condition having tolerated the procedure well. 

The physician reported 10121 x5 on the charge slip, and scar revision. In this scenario would this reporting be appropriate? Does the reapproximation of skin support the scar revision? Any help is appreciated!!


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## mbort

yes, except I do not see 5 incisions to justify the x5

Mary, CPC, COSC


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