ksb0211
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Hoping for other thoughts on this. I&D, Debridement, etc? Thanks for any help or thoughts.
PRE/POSTOPERATIVE DIAGNOSIS
Abscessed fistulous tracts, left upper extremity.
OPERATION PERFORMED
Exploration left forearm with debridement down to bone with excision of multiple tracts.
ANESTHESIA
General.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR, after induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics had been administered. The opening in the skin was noted in the left forearm posteriorly. The opening was cannulated with a 22 gauge Angiocath. It was then injected with a solution of peroxide with methylene blue. Once this was done, the previous incision was opened, utilizing a 15 blade. It was noted that this tract goes both to the volar and dorsal aspect. Multiple tunnels and tracts were identified. These were all carefully debrided. A granulation type tissue was appreciated in the tracts. The tract did extend down to the radius. Multiple connecting tunnels were appreciated. These were all opened and debrided until all of the necrotic tissue and staining from methylene blue was well excised. Once this was completed, the wounds were checked for hemostasis. The wound was thoroughly irrigated with a gentamicin solution. It was then packed with 4 x 4 soaked in gentamicin. The wound was then loosely closed with 3-0 nylon suture, packed and wrapped in sterile gauze.
The patient tolerated the procedure. The estimated blood loss was perhaps 100 mL. The patient was taken recovery room in stable condition.
PRE/POSTOPERATIVE DIAGNOSIS
Abscessed fistulous tracts, left upper extremity.
OPERATION PERFORMED
Exploration left forearm with debridement down to bone with excision of multiple tracts.
ANESTHESIA
General.
DESCRIPTION OF PROCEDURE
The patient was taken to the OR, after induction of adequate general anesthesia, the patient was prepped with DuraPrep and draped sterilely. Perioperative antibiotics had been administered. The opening in the skin was noted in the left forearm posteriorly. The opening was cannulated with a 22 gauge Angiocath. It was then injected with a solution of peroxide with methylene blue. Once this was done, the previous incision was opened, utilizing a 15 blade. It was noted that this tract goes both to the volar and dorsal aspect. Multiple tunnels and tracts were identified. These were all carefully debrided. A granulation type tissue was appreciated in the tracts. The tract did extend down to the radius. Multiple connecting tunnels were appreciated. These were all opened and debrided until all of the necrotic tissue and staining from methylene blue was well excised. Once this was completed, the wounds were checked for hemostasis. The wound was thoroughly irrigated with a gentamicin solution. It was then packed with 4 x 4 soaked in gentamicin. The wound was then loosely closed with 3-0 nylon suture, packed and wrapped in sterile gauze.
The patient tolerated the procedure. The estimated blood loss was perhaps 100 mL. The patient was taken recovery room in stable condition.
14 rvu