# Help with Op status post fasciotomy



## kibbit99 (Dec 23, 2008)

Can anyone help me with this Op Report.  Patient had a fasciotomy prior and this is a staged procedure.

I am having trouble with the I and D fasciotomy. 

DX: 
1.)Left Leg fasciotomy
2.) Thumb metacarpal shaft fracture, left

PROCEDURES:  
1.)	I and D fasciotomies, closure over drain and reapproximation
2.)	ORIF left thumb metacarpal 
3.)	Fluoroscopy two views left thumb

She was brought to the operating room and placed in the supine position and identified by myself.  Underwent general anesthesia in the usual fashion.  The left lower extremity as well as the left upper extremity was prepped and draped in the usual sterile fashion.  On her left thumb exsanguination was done with an Esmarch.  The tourniquet was inflated to 250 mmHg.  An incision was made in the dorsal aspect of the thumb. This was done through skin only.  Blunt dissection was done of the subcutaneous tissue.  The fascia was incised along the radial border and then the extensor tendon was retracted and protected at all times.  The thumb metacarpal shaft fracture was found to be unstable.  We opened it to find an oblique fracture and osteoporosis.  The bone and fracture was clamped and a 2-0 T plate was affixed and secured to the fracture.  We had to do a lag screw for the obliquity of the fracture and this added to the complexity duration of the case; however, the remainder of the screws were placed without difficulty.  After this was done, three views of the thumb metacarpal x-rays, AP, lateral, as well as oblique showed that the fracture was in good alignment as well as the hardware.  Copious irrigation was done using 3-0 Vicryl.  A portion of the retinaculum extensor hood was retracted using 3-0 Tycron.  The tourniquet came down at 60 minutes.  Hemostasis was obtained  Copious irrigation was done.  She was given a postop nerve block and then also her left leg fasciotomies were opened, irrigated with Pulsavac on  both sides.  The medial side was closed over a small Hemovac.  They both looked quite clean before and after Pulsavac and the lateral side was still too tight for reapproximating so we put vac on that again and then she was extubated and taken back to the recover room in stable condition.   


Thank you!


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## astrong3 (Dec 23, 2008)

*Perhaps you have your answer already but..*

Take a look at code 27600 and 27601.


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## kibbit99 (Dec 23, 2008)

I was looking at that, but he incised and drained the fasciotomy, which was done on a previous surgery.  It might just be an unlisted procedure 

27899?


Any other ideas are greatly appreciated. 

Thanks,

Kim


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