KBean2018
Guru
Hello, Please let me know if 19340-RT, 13101 would be appropriate. Any help is appreciated. thank you in advance
post-op Diagnosis:
Ruptured silicone breast implant, subsequent encounter [T85.49XD]
Wound dehiscence, surgical, subsequent encounter [T81.31XD]
Procedure:
IRRIGATION & DEBRIDEMENT BREAST WOUND / ABSCESS
BREAST IMPLANT EXCHANGE
The sutures of her right breast incision were removed. Her right breast implant was exposed. The dehiscence of her incision measured 1.5 cm in width by 3 cm in length extending from the IMF up to the vertical limb. Her nipple and areola form an ischemic eschar. I began by examining the implant pocket and removing the intact saline breast implant. There was no evidence of purulence within the implant pocket, only seroma. In inspecting the posterior aspect of the breast tissue which formed the anterior portion of the pocket there is a clear demarcation between what appeared to be viable breast tissue and ischemic breast tissue. Using a scalpel I incised the white nonviable appearing breast tissue which did not have healthy bleeding. This was the inferior portion of the breast tissue extending from the inferior aspect of the subglandular pocket all the way up to just above the nipple areolar complex. This accounted for the poor health of the patient's nipple and the resultant dehiscence of the incision. The decision was made to debride this tissue away as it would not be viable. The tissue was debrided and sent to pathology for examination. I debrided back to healthy brisk arterial bleeding. The skin edges were also examined and found to have healthy bleeding circumferentially. I did release some additional skin off of the superior breast tissue that remained in order to mobilize the skin flaps. I also released the subglandular pocket off of the pectoralis fascia in order to mobilize the pocket and replace and implant. The pocket was then copiously irrigated with 3 L of pulse lavage saline. Antibiotic irrigation was used with 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Electrocautery was used for hemostasis. A 10 French round JP drain was placed and secured with 4-0 nylon suture. My gloves were changed and a smooth round moderate plus saline implant was then placed in the pocket. I began closing the skin in layers using 2-0 Vicryl sutures in the dermis and 4-0 horizontal nylon mattress sutures to reapproximate the skin edges. I left the IMF incision open to allow the fill port for the saline implant to remain external. Then once the vertical limb was closed I began to fill the saline implant watching the amount of tension on the skin closure. The contralateral left breast implant is filled to 300 cc. Once I filled this right implant to 300 cc I checked the skin tension and was able to go to 350 cc on the right to achieve better symmetry. I then completed the closure of the IMF incision.
post-op Diagnosis:
Ruptured silicone breast implant, subsequent encounter [T85.49XD]
Wound dehiscence, surgical, subsequent encounter [T81.31XD]
Procedure:
IRRIGATION & DEBRIDEMENT BREAST WOUND / ABSCESS
BREAST IMPLANT EXCHANGE
The sutures of her right breast incision were removed. Her right breast implant was exposed. The dehiscence of her incision measured 1.5 cm in width by 3 cm in length extending from the IMF up to the vertical limb. Her nipple and areola form an ischemic eschar. I began by examining the implant pocket and removing the intact saline breast implant. There was no evidence of purulence within the implant pocket, only seroma. In inspecting the posterior aspect of the breast tissue which formed the anterior portion of the pocket there is a clear demarcation between what appeared to be viable breast tissue and ischemic breast tissue. Using a scalpel I incised the white nonviable appearing breast tissue which did not have healthy bleeding. This was the inferior portion of the breast tissue extending from the inferior aspect of the subglandular pocket all the way up to just above the nipple areolar complex. This accounted for the poor health of the patient's nipple and the resultant dehiscence of the incision. The decision was made to debride this tissue away as it would not be viable. The tissue was debrided and sent to pathology for examination. I debrided back to healthy brisk arterial bleeding. The skin edges were also examined and found to have healthy bleeding circumferentially. I did release some additional skin off of the superior breast tissue that remained in order to mobilize the skin flaps. I also released the subglandular pocket off of the pectoralis fascia in order to mobilize the pocket and replace and implant. The pocket was then copiously irrigated with 3 L of pulse lavage saline. Antibiotic irrigation was used with 500 cc NS and 1 gram ancef, 80 milligrams gentamycin, and 50,000 units of bacitracin. Electrocautery was used for hemostasis. A 10 French round JP drain was placed and secured with 4-0 nylon suture. My gloves were changed and a smooth round moderate plus saline implant was then placed in the pocket. I began closing the skin in layers using 2-0 Vicryl sutures in the dermis and 4-0 horizontal nylon mattress sutures to reapproximate the skin edges. I left the IMF incision open to allow the fill port for the saline implant to remain external. Then once the vertical limb was closed I began to fill the saline implant watching the amount of tension on the skin closure. The contralateral left breast implant is filled to 300 cc. Once I filled this right implant to 300 cc I checked the skin tension and was able to go to 350 cc on the right to achieve better symmetry. I then completed the closure of the IMF incision.