# Abdominal Wall Sinus Tract w Suture Granuloma



## coderguy1939 (Mar 5, 2009)

Patient developed an abdominal wall sinus tract following previous bowel resection.  The following is the dictated op report for excision of the sinus tract and removal of suture granuloma.   I'd appreciate some opionions and/or coding suggestions.

The patient was taken to the OR.  The area in the midline wound was chronically draining.  We probed this area.  After the area was prepped and draped, a time out was performed.  Local anesthetic was administered.  We probed the area of the sinus tract with a tonsil clamp and then did a wide elliptical excision of the area.  We were able to remove all the granulation-type hypertrophic tissue until we identified at the fascia a small silk suture that was the source of the suture granuloma.  We removed this area.  We did not enter the peritoneal cavity in itself.  However, after removing this offending silk suture, we did place an interrupted Vicryl suture to reinforce the fascial defect.  After this, the area was irrigated copiously with antibiotic and dilute Betadine.  We approximated the wound in layers and closed the skin with interrupted nylon suture in a vertical mattress fashion.

I'm leaning towards exicisional debridement, but would appreciate hearing from others.  Thanks.


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