# Excise chronic wound sinus, I&D abd abscess & removal foreign body



## lindacoder (Feb 1, 2011)

Patient has a history of prior trauma. At that time he had a feeding tube placed percutaneously. He has had, since it's removal an area of chronic drainage on the abdomen. He has had an abdominal x-ray which shows a metallic foreign body in this area. He is brought to the operating room for excision of this and removal of the foreign body to hopefully allow healing of this wound.
An elliptical incision was made around the chronic draining wound area on the patient's abdomen. This was carried down into the subcutaneous tissue and down to the anterior abdominal wall fascia. There was a tract that tracked through the muscle to the peritoneum. This was taken down to the peritoneum and then divided. It appeared t hat the stomach was adherent under this area. By history this site had been a jejunostomy tube but this did appear more like stomach. There was no obvious hole in the bowel or stomach here but the area of oversewn with 3-0 PDS suture. The muscle and fascia were then reclosed over this area with an 0 PDS suture. I did not identify the foreign body at this site. The patient, more superior on the abdomen had a fluctuant area. I incised and drained this area and found a fluid collection here. This was cultured. In the base of this was a foreign body. This appeared like a radiologic T-fastener used sometimes in feeding tube placement. This was removed and passed as specimen along with the wound sinus. This area tracked down to the initial tube tract.The sinus site incision was then closed in layers with a deep layer of 2-0 Vicryl.  We did partially approximate the skin but left partial areas open and did put a wick gauze down the the fascia level. The incision and drainage site superiorly was partially closed as well but the gauze wick was placed down to the base of this wound as well. A bulky gauze dressing was applied. 

I am looking at 10121 for foreign body removal and 13160 for the chronic wound sinus - any other suggestions???????

Thanks


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