TWilliam2019
Guru
Procedure list in detail:
1. Evacuation of hematoma
2. Exploration of right femoral vessels with repair of right femoral artery pseudoaneurysm
3. Thrombectomy of iliofemoral and femoral-popliteal bypass grafts
4. Placement of wound VAC
Procedure Details:
Patient was brought emergently to the operating room after she developed acute hemorrhage and hematoma on the floor. The patient was status post a recent sartorius flap coverage and rotational flap skin coverage of a left groin wound that had complicated previous iliofemoral and femoral-popliteal bypass graft.
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Patient's left groin was prepped and with ChloraPrep while manual pressure was held to achieve hemostasis. General anesthesia was induced. The previous rotational skin flap was mobilized and the hematoma evacuated. The iliofemoral graft was clamped which controlled the bleeding. A disruption of the femoral hood of the iliofemoral graft to the common femoral artery was discovered in the mid medial suture line. This was repaired with a pledgeted core matrix patch ×2. The wound showed no obvious gross infection although the graft disruption is certainly worrisome for graft infection to this point.
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Following repair of the femoral artery pseudoaneurysm the graft was noted be pulseless. Graftotomy was performed and Fogarty catheters were passed proximally and distally and acute and subacute thrombus was retrieved. Brisk inflow was established. Atherosclerotic passed distally and additional thrombus was retrieved. Fogarty catheters were passed into an no additional thrombus could be retrieved on several negative passes. The graftotomy was repaired and flow reestablished. Rotational flap was left in position to cover the graft but low urine of the donor site was not really feasible to this point. We have elected to place a wound VAC device at this time. Patient tolerated procedure well and was adequately resuscitated by the anesthesia services during the case.
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35141
34201
1. Evacuation of hematoma
2. Exploration of right femoral vessels with repair of right femoral artery pseudoaneurysm
3. Thrombectomy of iliofemoral and femoral-popliteal bypass grafts
4. Placement of wound VAC
Procedure Details:
Patient was brought emergently to the operating room after she developed acute hemorrhage and hematoma on the floor. The patient was status post a recent sartorius flap coverage and rotational flap skin coverage of a left groin wound that had complicated previous iliofemoral and femoral-popliteal bypass graft.
*
Patient's left groin was prepped and with ChloraPrep while manual pressure was held to achieve hemostasis. General anesthesia was induced. The previous rotational skin flap was mobilized and the hematoma evacuated. The iliofemoral graft was clamped which controlled the bleeding. A disruption of the femoral hood of the iliofemoral graft to the common femoral artery was discovered in the mid medial suture line. This was repaired with a pledgeted core matrix patch ×2. The wound showed no obvious gross infection although the graft disruption is certainly worrisome for graft infection to this point.
*
Following repair of the femoral artery pseudoaneurysm the graft was noted be pulseless. Graftotomy was performed and Fogarty catheters were passed proximally and distally and acute and subacute thrombus was retrieved. Brisk inflow was established. Atherosclerotic passed distally and additional thrombus was retrieved. Fogarty catheters were passed into an no additional thrombus could be retrieved on several negative passes. The graftotomy was repaired and flow reestablished. Rotational flap was left in position to cover the graft but low urine of the donor site was not really feasible to this point. We have elected to place a wound VAC device at this time. Patient tolerated procedure well and was adequately resuscitated by the anesthesia services during the case.
*
35141
34201