donnagullikson
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Need help coding this report please.
She was laid supine and was given general anesthesia. Left arm was prepped and a sharp incision through the previous incision in the medial aspect of the arm above the antecubital fossa was made. Almost immediately, there was a graft that was poking through the skin. I followed this down to the brachial artery which was totally encased in the scar tissue. I extended my incision proximally and distally to get around clean brachial artery. 6000 units of heparin was given. I was able to dissect free the heavy amount of scar tissue. I excised the graft in its entirety, however, I was not able to get down a clean arterial wall due to all the scar tissue. Using ultrasound, I identified a piece of cephalic vein in the arm lateral to my previous incision. I went ahead and made about 6 cm incision here and harvested a piece of cephalic vein. This was adequate length for patch. I then opened up the brachial artery itself through this are of lymphatic scar tissue. I made sure we had all the grafts removed from the wall and were on clean tissue. I then sewed on the patch with 6-0 Prolene suture. I allowed back bleeding flush for complete anastomosis. There was a good signal in ulnar and the palmar arch. I went ahead and irrigated with antibiotic irrigation. Closed with multiple layers of 3-0 Vicryl sutures followed by nylon for the skin.
Thanks in advance for the help.
She was laid supine and was given general anesthesia. Left arm was prepped and a sharp incision through the previous incision in the medial aspect of the arm above the antecubital fossa was made. Almost immediately, there was a graft that was poking through the skin. I followed this down to the brachial artery which was totally encased in the scar tissue. I extended my incision proximally and distally to get around clean brachial artery. 6000 units of heparin was given. I was able to dissect free the heavy amount of scar tissue. I excised the graft in its entirety, however, I was not able to get down a clean arterial wall due to all the scar tissue. Using ultrasound, I identified a piece of cephalic vein in the arm lateral to my previous incision. I went ahead and made about 6 cm incision here and harvested a piece of cephalic vein. This was adequate length for patch. I then opened up the brachial artery itself through this are of lymphatic scar tissue. I made sure we had all the grafts removed from the wall and were on clean tissue. I then sewed on the patch with 6-0 Prolene suture. I allowed back bleeding flush for complete anastomosis. There was a good signal in ulnar and the palmar arch. I went ahead and irrigated with antibiotic irrigation. Closed with multiple layers of 3-0 Vicryl sutures followed by nylon for the skin.
Thanks in advance for the help.