Good morning. I was hoping someone might be able to help me with the following op report.
Postoperative dx: Septic avascular necrosis of the rt hip w/extensive acetabular bone loss as well as a noted subcutateous infection anterolateral aspect of the patient's thigh.
Procedure: Femoral head ostectomy w/insertion of an antibiotic unipolar spacer, irriagation and debridement both deep and superficial.
...Careful dissection was carried down to pt's tensor fascia lata which was incised and retracted, immediately noting the pt had extensive subcu tissues distally just above the fascia lata on the anterolateral aspect of the hip which required further investigation and debridement. The deep tissues were scarred extensively, so much so that the gluteus maximus was scarred to the gluteus medius and the tensor fascia lata was scarred for the most part to the vastus lateralis as well as the bursa. Taking quite some time to get through, there is a perforation which was greater than 2.5 cm in diameter through the capsule in the posterior superior aspect of the capsule. The amt of scarring continued into the pt's acetabulum and this all required extensive debridement. All debridement both superficial and deep were excisional. Debridement was then carried out, the capsulotomy was performed superior to anterior and inferior to anterior. Once this was performed the remainder of the debridement of the pt's synovium was then carried out. we then finally broached and reamed for a #13 Biomet stem, trialed, and noted this to be grossly stable. We then subsequently continued the debridement, irrigated out with 9 liters of antibiotic solution, then reinserted the cement antibiotic spacer, reduced one more time and then reanastomosed what remnants of the external rotators and the capsule were with #2 Monocryl. The tensor fascia lata was reanastomosed w/a #1 Monocryl subcutaneous tissue w/ 2-0 Monocryl and skin with staples. Two drains inserted both superficial and deep.
Any help w this would be very much appreciated!
Postoperative dx: Septic avascular necrosis of the rt hip w/extensive acetabular bone loss as well as a noted subcutateous infection anterolateral aspect of the patient's thigh.
Procedure: Femoral head ostectomy w/insertion of an antibiotic unipolar spacer, irriagation and debridement both deep and superficial.
...Careful dissection was carried down to pt's tensor fascia lata which was incised and retracted, immediately noting the pt had extensive subcu tissues distally just above the fascia lata on the anterolateral aspect of the hip which required further investigation and debridement. The deep tissues were scarred extensively, so much so that the gluteus maximus was scarred to the gluteus medius and the tensor fascia lata was scarred for the most part to the vastus lateralis as well as the bursa. Taking quite some time to get through, there is a perforation which was greater than 2.5 cm in diameter through the capsule in the posterior superior aspect of the capsule. The amt of scarring continued into the pt's acetabulum and this all required extensive debridement. All debridement both superficial and deep were excisional. Debridement was then carried out, the capsulotomy was performed superior to anterior and inferior to anterior. Once this was performed the remainder of the debridement of the pt's synovium was then carried out. we then finally broached and reamed for a #13 Biomet stem, trialed, and noted this to be grossly stable. We then subsequently continued the debridement, irrigated out with 9 liters of antibiotic solution, then reinserted the cement antibiotic spacer, reduced one more time and then reanastomosed what remnants of the external rotators and the capsule were with #2 Monocryl. The tensor fascia lata was reanastomosed w/a #1 Monocryl subcutaneous tissue w/ 2-0 Monocryl and skin with staples. Two drains inserted both superficial and deep.
Any help w this would be very much appreciated!