# Joint Scar Contracture Release - How would you code this?



## plasticscoder (May 16, 2012)

Can't determine if we should go with 14040/15050/[20650?-insertion of pin] OR refer to hand codes? Please help, thanks.


PREOPERATIVE DIAGNOSIS:   Severe scar contracture of distal interphalangeal  and proximal interphalangeal joints, left ring finger.

POSTOPERATIVE DIAGNOSIS:  Severe scar contracture of distal interphalangeal  and proximal interphalangeal joints, left ring finger.


OPERATION:
   1. Excision and release of volar scar tissue, left ring finger, 1 cm x 3    cm.
   2. Volar rearrangement of tissue.
   3. Full-thickness skin graft x2, each 1 x 1.5 cm, volar left ring    finger.
   4. Release of contractures and K-wire fixation of proximal    interphalangeal and distal interphalangeal joints.    5. Bulky dressing.


FINDINGS/TECHNIQUE:  The patient was placed in the supine position, where  he was sterilely prepped and draped.  A tourniquet was inflated to 200 mmHg  after exsanguination by direct pressure.  A zigzag incision was made on the  volar aspect over the scar tissue.  Scar tissue was carefully dissected.  Discarded flaps were thinned to appropriate thickness and then transposed  to cover the middle phalanx volar tissue, leaving open wound of the DIP and  volar PIP joints.  This skin was then harvested transversely at the ulnar  wrist crease and longitudinally over the ulnar hypothenar region.  Both  these areas were harvested with a 15-blade scalpel, defatting the  full-thickness graft in place.  Closure of the donor sites was done with  deep interrupted 5-0 Monocryl sutures and 5-0 chromic for skin  approximation.  Skin grafts were then sutured into place with 5-0 chromic  catgut.  The tourniquet was deflated.  A pressure dressing was applied.  Then Xeroform was applied to the finger.  Hyper-extension of the DIP joint was  done with a single 28-gauge wire longitudinally, and another wire was  passed for the PIP joint in full extension.  A bulky dressing was applied,  including an Ace wrap.  The patient tolerated the procedure well and was  transferred to the recovery room in satisfactory condition.


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