bda23054
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NAME OF OPERATION
Surgical debridement and wound V.A.C. dressing change of abdominal wall wound.
ANESTHESIA
Monitored anesthesia care.
ESTIMATED BLOOD LOSS
None.
FINDINGS
The wound measurements were essentially the same as 48-hours ago, being about 12 cm length, 3-4 cm gapping, and about 3 cm depth with the lower edge of the wound base having fascial communication about 3 cm in diameter. No purulent drainage build up appreciated. No bile stained drainage appreciated. No grossly exposed bowel. There was quite a bit of slough and nonviable connective tissue exposed, though there was a little bit of granulation tissue around the edges starting to develop it appears. The fascial suture was still exposed at the base of the wound. No new fascial breakdown spots were appreciated. No significant change in the wound dimensions with removal of connective tissue that was nonviable as well as sloughing of fascia and subcutaneous tissue.
DESCRIPTION OF OPERATION
The procedure as well as indications, benefits and potential risks were explained to the patient. All questions were answered. With consent obtained, the patient was taken to the Operative Suite, placed in the supine position and adequate sedated initiated and maintained throughout this procedure. As the abdominal wall was exposed the old wound V.A.C. dressing was removed. The colostomy was isolated with adhesive plastic sheath and the midline incision was prepped and draped in the usual sterile fashion. The wound was irrigated with a liter of Betadine tinged saline followed by a liter of sterile saline and Metzenbaum scissors and forceps were used to selectively remove nonviable tissue, again taking care not to injure any underlying structures with the planes fairly obscured with healing process. The fascial communication was digitally explored gently, again with no accumulation of purulent drainage intra-abdominally appreciated or succus material. Mepilex was then secured to the silver sponge with a 3-0 Prolene stitch and placed at the base of the wound once it was cut to fit. Occlusive dressing was applied over the sponge and the negative pressure was applied as per manufacturer's instructions. No air leaks appreciated. The patient was awakened and taken to the Recovery Room in stable and satisfactory condition. All sponge and instrument counts correct.
NAME OF OPERATION
Surgical debridement and wound V.A.C. dressing change of abdominal wall wound.
ANESTHESIA
Monitored anesthesia care.
ESTIMATED BLOOD LOSS
None.
FINDINGS
The wound measurements were essentially the same as 48-hours ago, being about 12 cm length, 3-4 cm gapping, and about 3 cm depth with the lower edge of the wound base having fascial communication about 3 cm in diameter. No purulent drainage build up appreciated. No bile stained drainage appreciated. No grossly exposed bowel. There was quite a bit of slough and nonviable connective tissue exposed, though there was a little bit of granulation tissue around the edges starting to develop it appears. The fascial suture was still exposed at the base of the wound. No new fascial breakdown spots were appreciated. No significant change in the wound dimensions with removal of connective tissue that was nonviable as well as sloughing of fascia and subcutaneous tissue.
DESCRIPTION OF OPERATION
The procedure as well as indications, benefits and potential risks were explained to the patient. All questions were answered. With consent obtained, the patient was taken to the Operative Suite, placed in the supine position and adequate sedated initiated and maintained throughout this procedure. As the abdominal wall was exposed the old wound V.A.C. dressing was removed. The colostomy was isolated with adhesive plastic sheath and the midline incision was prepped and draped in the usual sterile fashion. The wound was irrigated with a liter of Betadine tinged saline followed by a liter of sterile saline and Metzenbaum scissors and forceps were used to selectively remove nonviable tissue, again taking care not to injure any underlying structures with the planes fairly obscured with healing process. The fascial communication was digitally explored gently, again with no accumulation of purulent drainage intra-abdominally appreciated or succus material. Mepilex was then secured to the silver sponge with a 3-0 Prolene stitch and placed at the base of the wound once it was cut to fit. Occlusive dressing was applied over the sponge and the negative pressure was applied as per manufacturer's instructions. No air leaks appreciated. The patient was awakened and taken to the Recovery Room in stable and satisfactory condition. All sponge and instrument counts correct.