KBean2018
Guru
Hello, I am unfamiliar with tram flaps and debridement. I was leaning towards 11042 x 5. Any help appreciated. thank you
The surgeon sharply debrided the areas of necrotic skin overlying her TRAM flap. After debridement the total area of skin and subcutaneous tissue that was debrided measured 20 cm x 5 cm inferiorly and 5 x 4 cm at the superomedial aspect. The depth of the wound measured 0.5 cm. There was also undermining at the superior medial aspect measuring a 4 x 8 cm ellipse. Debridement stopped at the level of the subcutaneous fat where there was attachment between the TRAM flap and the surrounding chest wall radiated skin. This indicated healthy tissue that was able to show signs of healing. There was also some evidence of bleeding with bright red blood at these areas. While performing the debridement I noticed areas of hematoma, venous congestion, and thrombosed veins consistent with her history of undrained hematoma and venous congestion of her flap as a result of compressed pedicle. There was no sign of infection only some necrotic fat noted. The tissue that was debrided was sent to pathology. The wound was irrigated with saline. Then a black foam sponge was cut to fit and a wound VAC was placed and set to 125 mm of low continuous suction. The patient's JP drains from her prior surgery remained in place as she did not bring her drain records. We will keep her in the hospital to arrange home wound VAC and home nursing. We will monitor her drain output while she is in the hospital and remove them if possible. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.
The surgeon sharply debrided the areas of necrotic skin overlying her TRAM flap. After debridement the total area of skin and subcutaneous tissue that was debrided measured 20 cm x 5 cm inferiorly and 5 x 4 cm at the superomedial aspect. The depth of the wound measured 0.5 cm. There was also undermining at the superior medial aspect measuring a 4 x 8 cm ellipse. Debridement stopped at the level of the subcutaneous fat where there was attachment between the TRAM flap and the surrounding chest wall radiated skin. This indicated healthy tissue that was able to show signs of healing. There was also some evidence of bleeding with bright red blood at these areas. While performing the debridement I noticed areas of hematoma, venous congestion, and thrombosed veins consistent with her history of undrained hematoma and venous congestion of her flap as a result of compressed pedicle. There was no sign of infection only some necrotic fat noted. The tissue that was debrided was sent to pathology. The wound was irrigated with saline. Then a black foam sponge was cut to fit and a wound VAC was placed and set to 125 mm of low continuous suction. The patient's JP drains from her prior surgery remained in place as she did not bring her drain records. We will keep her in the hospital to arrange home wound VAC and home nursing. We will monitor her drain output while she is in the hospital and remove them if possible. The patient was awoken from anesthesia without complication and transferred to the recovery room in stable condition. At the end of the case all the needle, sponge and instrument counts were correct x 2 and I was present for the entire case.