# excisional debridement and skin grafting



## Jcelin (Aug 18, 2014)

Please need help for this procedure.....


operation performed: wide excisional debridement of an infected seroma with a total bursectomy and pulse lavage, harvesting of split-thickness  skin graft, application of wound vac, and a drainage procedure.

pre-op dx: infected seroma of right hip
post-opdx: infected seroma of right hip

findings: infected bursa and wound cultures. there was a small opening extending down to the hip joint.

time: case begun at 5:15 ended at 9:35 

wound measurement 47cm x 15cm x5cm deep

estimated blood loss: 350 ml to 700ml

procedure:
the patient was taken to the operating room, placed in a right lateral decubitus position and after adequate endotracheal anesthesia, was prepped and draped in the usual fashion. the patient was in a right lateral decubitus position.

There is longitudinal scar on the right hip with a marked bulging and fluctuance over the area. we eliptically excised the skin over that are down through the skin and subcutaneous tissue, encountering marked scar tissue and then into the bursa. The bursa had seropurulent material. wound cultures were taken  of the area, both aerobic and anearobic. that having been completed, we removed the segment of the nonviable skin and continued the incision downward. There were multiple area of loculation, one below the tensor fascia lata, one above the tensor fascia lata, one extending anteriorly to the hip, and when debrided an area approximately the sixe of a dime extending down just above the capsule of the hip joint. we extended the incision down to almost 1 fingerbreadth above the knee. That having been completed, we elevated the 2 flaps and encountered the bursa. We suctioned all the tissue. We had separate cultures of the area extending down into the joint capsule with aerobic and anearobic cultures. That having been completed, after removing the entire bursa, we curretted the areas of pocketing, removed the bursa, and sent it to pathological evaluation.

Next, we pulse lavaged it with 12 l of double antibiotic solution. That having been completed, 4 jackson-pratt drains were placed, one #7 into just above the joint capsule, and 3 one anteriorly extending up into the anterior thigh and 2 along the lateral gutters of the incisions extending in the inferior margin of the incision.

Next, we applied quilting sutures, ie. horizontal mattres sutures through and through the skin into the fascia of the tensor fascia lata, then back out throgh the skin again, and tied them over pledgets. That having been completed, we advanced the tissue forward, closing the upper portion and the lower portion of the wounds leaving the defect aprox 7 inches x 4 inches down to the fascia. After tying aproximately 10 of the tuck sutures, we sutured the drains in with 3.0 nylon suture and covered and stapled the skin together wit a staple gun. We covered those with xeroform, sorroundedd the area with benzoin, placed the jackson-pratts on a below suction, added a block sponged to the area, placed the patient on a wound vac. the wound vac was 175 mmHg high intensity on a continous flow.

The patient was the placed i a supine position. we prepped the left thigh and harvested a split-thickness skin graft 3 inches x 15 inches x 1/12,000 of an inch off from the left thigh and placed it in Xeroform and moist 4x4's for subsequent use. The donor site was covered  with xeroform and OpSite. The left thigh had adequate capture of the vac and the jackson-pratt drains.

the patient was transferred to a clinitron rite hite bed, the head was elevated. tolerated procedure well.

My code was:
CPT: 27027-RT; 27062-RT; 15100-RT;15101-RT (2 UNITS)
ICD: 726.5 ; 998.51

ANY OTHER ANSWER? OR AM I CODED IT RIGHT? PLEASE ANY COMMENT IS GREATLY APPRECIATED.


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