herrera4
Guru
would the cpt 15830 be used for the removal of excess skin to help obliterate dead space? would the insurance even cover it since its usually for cosmetic purposes?TIA
The patient was brought to the operating room and placed in supine position. Following induction of general anesthesia, he was prepped and draped in the usual sterile fashion using ChloraPrep. The staples were removed from midline wound and using hemostat, the large hematoma/seroma cavity was entered. Suction was used to suction free the hematoma/seroma. Remaining staples were removed and the abdominal wall subcu was debrided using gentle blunt dissection and irrigation. As noted above, the fascia was quite intact. There was some question about the viability of the skin edges on the right side. This was trimmed with tenotomy scissors. Given the large dead space, it was elected to excise the excess skin and subcutaneous tissue from the left side. An ellipse of skin measuring 4 x 20 cm was excised full thickness including the subcutaneous tissue. This allowed for a much tighter abdominal closure. Bleeding points were controlled with cautery when encountered and the wound was irrigated with Ancef solution. Large Hemovac drain was then placed in the subcutaneous space and subcu was approximated using subdermal sutures of 2-0 Vicryl followed by staples for the skin. This was followed by dry sterile dressing and Tegaderm. The patient tolerated the procedure well and was brought back to the recovery room in stable condition.
The patient was brought to the operating room and placed in supine position. Following induction of general anesthesia, he was prepped and draped in the usual sterile fashion using ChloraPrep. The staples were removed from midline wound and using hemostat, the large hematoma/seroma cavity was entered. Suction was used to suction free the hematoma/seroma. Remaining staples were removed and the abdominal wall subcu was debrided using gentle blunt dissection and irrigation. As noted above, the fascia was quite intact. There was some question about the viability of the skin edges on the right side. This was trimmed with tenotomy scissors. Given the large dead space, it was elected to excise the excess skin and subcutaneous tissue from the left side. An ellipse of skin measuring 4 x 20 cm was excised full thickness including the subcutaneous tissue. This allowed for a much tighter abdominal closure. Bleeding points were controlled with cautery when encountered and the wound was irrigated with Ancef solution. Large Hemovac drain was then placed in the subcutaneous space and subcu was approximated using subdermal sutures of 2-0 Vicryl followed by staples for the skin. This was followed by dry sterile dressing and Tegaderm. The patient tolerated the procedure well and was brought back to the recovery room in stable condition.
