codedog
True Blue
Hello, how would you could the size of this 12x7? is it 84 sq. cm? am I going in the right direction ?
POSTOPERATIVE DIAGNOSIS: Infected necrotic eschar with the underlying hematoma.
Basically infected hematoma, basically crushed necrotic fat and fascia over
the anterior compartment. No evidence of any necrotizing fasciitis. The
underlying muscle was viable.
OPERATIVE PROCEDURE: Excisional debridement using sharp dissection of necrotic
skin, covering an area of about 12-15 cm x 7 cm, also evacuation of subcutaneous
hematoma debrided, sharp and blunt debridement of necrotic subcutaneous fat 12
x 7 cm area was necrotic or infected, also some necrotic fascia overlying the
anterior compartment. There is no evidence of any fasciitis or extension of any
infection of the fascia proximally or distally. Pulsavac evacuation of the
wound using 2 liters of Pulsavac irrigation.
SPECIMEN: The specimen was necrotic skin, fat and fascia. Also, cultures were
sent for aerobic and anaerobic.
OPERATIVE PROCEDURE: After adequate general anesthesia obtained in supine
position, the patient's left lower extremity from the thigh down to the toes was
prepped and draped in sterile fashion. After this was done, there was an area
about 15 x 7 cm of necrotic skin on the anterolateral thigh and using sharp
dissection with scissors this necrotic skin was removed, skin edges were
carefully examined and anything was not viable was excised down to viable and
oozing skin. Underneath this skin, there was a hematoma, which was washed out,
washing hematoma most of the subQ fat was gone in this area underneath the area
of necrotic skin down to the muscle. The muscle fascia around the anterior
compartment was pretty much destroyed probably represented a crush injury.
Necrotic fascia was excised also, the fascia was basically opened up superiorly,
inferiorly in the anterior compartment. Below this area of open wound, the
fascia was viable. No evidence of fasciitis. Some of the subcutaneous fat
lateral this opening was necrotic and it was excised. Beyond this crushed area
of skin, a hematoma and necrotic skin superiorly and inferiorly the fascia, the
fat was viable. There was some exposed tendon distally with this fascia and fat
had been destroyed by the crush injury. The muscle underneath was viable and
healthy. After debriding this nonviable tissue, the wound was irrigated with
about 2 liters with using the Pulsavac. The area was examined again and any
remaining small areas of fascial or skin was excised. The skin proximal to
this, had some abrasions on and using Hibiclens scrub abrasions were scrubbed
and small superficial eschar were excised down to viable skin. The wound was
then packed with a moist saline gauze, 4 x 4s and Kerlix wrap. The patient was
awakened in Operating Room and taken to Recovery Room in stable condition.
thank you for your time
POSTOPERATIVE DIAGNOSIS: Infected necrotic eschar with the underlying hematoma.
Basically infected hematoma, basically crushed necrotic fat and fascia over
the anterior compartment. No evidence of any necrotizing fasciitis. The
underlying muscle was viable.
OPERATIVE PROCEDURE: Excisional debridement using sharp dissection of necrotic
skin, covering an area of about 12-15 cm x 7 cm, also evacuation of subcutaneous
hematoma debrided, sharp and blunt debridement of necrotic subcutaneous fat 12
x 7 cm area was necrotic or infected, also some necrotic fascia overlying the
anterior compartment. There is no evidence of any fasciitis or extension of any
infection of the fascia proximally or distally. Pulsavac evacuation of the
wound using 2 liters of Pulsavac irrigation.
SPECIMEN: The specimen was necrotic skin, fat and fascia. Also, cultures were
sent for aerobic and anaerobic.
OPERATIVE PROCEDURE: After adequate general anesthesia obtained in supine
position, the patient's left lower extremity from the thigh down to the toes was
prepped and draped in sterile fashion. After this was done, there was an area
about 15 x 7 cm of necrotic skin on the anterolateral thigh and using sharp
dissection with scissors this necrotic skin was removed, skin edges were
carefully examined and anything was not viable was excised down to viable and
oozing skin. Underneath this skin, there was a hematoma, which was washed out,
washing hematoma most of the subQ fat was gone in this area underneath the area
of necrotic skin down to the muscle. The muscle fascia around the anterior
compartment was pretty much destroyed probably represented a crush injury.
Necrotic fascia was excised also, the fascia was basically opened up superiorly,
inferiorly in the anterior compartment. Below this area of open wound, the
fascia was viable. No evidence of fasciitis. Some of the subcutaneous fat
lateral this opening was necrotic and it was excised. Beyond this crushed area
of skin, a hematoma and necrotic skin superiorly and inferiorly the fascia, the
fat was viable. There was some exposed tendon distally with this fascia and fat
had been destroyed by the crush injury. The muscle underneath was viable and
healthy. After debriding this nonviable tissue, the wound was irrigated with
about 2 liters with using the Pulsavac. The area was examined again and any
remaining small areas of fascial or skin was excised. The skin proximal to
this, had some abrasions on and using Hibiclens scrub abrasions were scrubbed
and small superficial eschar were excised down to viable skin. The wound was
then packed with a moist saline gauze, 4 x 4s and Kerlix wrap. The patient was
awakened in Operating Room and taken to Recovery Room in stable condition.
thank you for your time