Any opions on what procedure code to use would be greatly appreciated.
PreOperative DX: Abscess lateral Rt thigh
PostOperative DX: Rt THR periprosthetic infection
Operation Tenique:
The area of the sinus tract was along the distal aspect of the previous incision. This was excised elliptically. It was extended slightly distal and also proximal. This was taken down through subcutaneous tissue. The patient was bleeding quite a bit, with any manipulation of the tissue. Electrocautery was used, but she was certainly bleeding as though she was on anticoagulant. We tried to keep the field as clean and dried as possible. We then proceeded down into the subcutaneous sinus tract, we then took methylene blue and mixed this with saline solution and then injected it with a syringe into the sinus tract so that we can hopefully tell the extent of the lesion. This dissection was then continued. The sinus tract went throught the fascia of the iliotibial band and then extended posterior along the muscle belly of the vastus lateralis and tract proximal. It was followed with finger palpation and I then extended the incision proximal, continued to unrood the soft tissue and followed the path of the sinus tract. This led down into an abscess along the posterior aspect of the vastus lateralis and was confined to that muscular compartment. It was followed proximal and it did extend along the posterior aspect of the femur, over the top of the gluteus maximus insertion along the back of the femur and unfortunately, continued up into the hip joint. The methylene blue did not extend up into this area but there was discernable track of tissue which appeared to be inflamed and consistent with a continous abscess up into the posterior capsule of the hip joint and into the hip joint itself. The patients starting hemoglobin was only 9.5. As mentioned, she was bleeding in a general low grade but in consistant fashion and I was really concerned about doing too much today to in the way of debridement and losing too much blood and getting her hemoglobin too low. Therefore, this was limited. Once I found that went into the right hip joint, it was evident that we were not going to be embarking on a big operation to remove her components today, at this point I cleaned up the area as well as we could, debrided it and then proceeded to place a wound VAC. We also put an irrigation line directly running down into the right hip joint. This was exiting out a percoutaneous stab incision in the anterior distal thigh. This will be for antibiotice irrigation. The wound was then filled with a wound VAC sponge, the proximal 80% or so of the wound was closed with a #1 Prolene running suture in subcuticular fashion. the very distal portion of the wound was left open so that we had access to the wound VAC sponge. The occlusive dressing was placed, a disc was placed on the wound VAC sponge and activated to -125mm continuous negative suction. The patient was taken to the recovery in stable condition after tolerating the procedure well.
PreOperative DX: Abscess lateral Rt thigh
PostOperative DX: Rt THR periprosthetic infection
Operation Tenique:
The area of the sinus tract was along the distal aspect of the previous incision. This was excised elliptically. It was extended slightly distal and also proximal. This was taken down through subcutaneous tissue. The patient was bleeding quite a bit, with any manipulation of the tissue. Electrocautery was used, but she was certainly bleeding as though she was on anticoagulant. We tried to keep the field as clean and dried as possible. We then proceeded down into the subcutaneous sinus tract, we then took methylene blue and mixed this with saline solution and then injected it with a syringe into the sinus tract so that we can hopefully tell the extent of the lesion. This dissection was then continued. The sinus tract went throught the fascia of the iliotibial band and then extended posterior along the muscle belly of the vastus lateralis and tract proximal. It was followed with finger palpation and I then extended the incision proximal, continued to unrood the soft tissue and followed the path of the sinus tract. This led down into an abscess along the posterior aspect of the vastus lateralis and was confined to that muscular compartment. It was followed proximal and it did extend along the posterior aspect of the femur, over the top of the gluteus maximus insertion along the back of the femur and unfortunately, continued up into the hip joint. The methylene blue did not extend up into this area but there was discernable track of tissue which appeared to be inflamed and consistent with a continous abscess up into the posterior capsule of the hip joint and into the hip joint itself. The patients starting hemoglobin was only 9.5. As mentioned, she was bleeding in a general low grade but in consistant fashion and I was really concerned about doing too much today to in the way of debridement and losing too much blood and getting her hemoglobin too low. Therefore, this was limited. Once I found that went into the right hip joint, it was evident that we were not going to be embarking on a big operation to remove her components today, at this point I cleaned up the area as well as we could, debrided it and then proceeded to place a wound VAC. We also put an irrigation line directly running down into the right hip joint. This was exiting out a percoutaneous stab incision in the anterior distal thigh. This will be for antibiotice irrigation. The wound was then filled with a wound VAC sponge, the proximal 80% or so of the wound was closed with a #1 Prolene running suture in subcuticular fashion. the very distal portion of the wound was left open so that we had access to the wound VAC sponge. The occlusive dressing was placed, a disc was placed on the wound VAC sponge and activated to -125mm continuous negative suction. The patient was taken to the recovery in stable condition after tolerating the procedure well.