The doctor's code selection for the irrigation and debridement is 25028, my code selection is 11043.
PROCEDURES PERFORMED: Left elbow:
1. Irrigation and debridement.
2. MicroGen cultures.
3. Revision distal biceps tendon reconstruction using autograft
semitendinosus tendon from the left knee
We first turned our attention to the left knee where a longitudinal
incision was made over the hamstring tendon and dissection was carried out
through skin and subcutaneous tissue, through the deep fascia and pes and
sartorius fascia, identifying the semitendinosus tendon. It was then
harvested without complication. We got a nice excellent tendon. The
incision was then closed. We then went to the elbow and did not inflate
the tourniquet, but did reopen his previous incision. We did have some
fluid present in the area, which we sent for cultures, also took some
tissue samples and also swabbed the area in multiple spots. There was no
gross pus present, just a little bit of some fluid. We then very carefully
dissected out his previously placed allograft and we felt that it was
possible he was having reaction to the allograft and/or has an indolent
infection that has been culture negative, but I talked to him
preoperatively, and he preferred to have the allograft tendon removed and
replaced with autograft, which was very reasonable. We very carefully
again dissected out the tendon. It had a significant amount of scar tissue
around it. We were very careful dissecting it down to the tuberosity. Down
at the tuberosity, there was some heterotopic ossification that had
developed that we removed. We carefully kept the forearm supinated to
protect the posterior interosseous nerve. We did remove the allograft. We
left some of it in the actual distal biceps at the musculotendinous
junction, so we did have a tendon to fixate the autograft to. We
identified the tuberosity. We removed some sutures present in the previous
tendon as well, again debrided down to the tuberosity and then we used two
suture anchors, placed one more proximally to the tuberosity at the
proximal aspect of the tuberosity and secured the one end of the tendon to
the bone in that area. We then weaved it through the distal biceps to the
musculotendinous junction, secured it at appropriate tension and then
brought he other limb down and secured it with a PushLock anchor, and felt
we had good tension. We then used the extra part of the graft and weaved
it one more time through the distal portion of the tendon to get a good
graft present. We then deflated the tourniquet and achieved good
hemostasis. We irrigated it again multiple times and made sure we debrided
all potential sources of infection areas and then closed the incision and
placed him into a posterior mold splint. He tolerated the procedure well
and was transferred to recovery room in stable condition.
PROCEDURES PERFORMED: Left elbow:
1. Irrigation and debridement.
2. MicroGen cultures.
3. Revision distal biceps tendon reconstruction using autograft
semitendinosus tendon from the left knee
We first turned our attention to the left knee where a longitudinal
incision was made over the hamstring tendon and dissection was carried out
through skin and subcutaneous tissue, through the deep fascia and pes and
sartorius fascia, identifying the semitendinosus tendon. It was then
harvested without complication. We got a nice excellent tendon. The
incision was then closed. We then went to the elbow and did not inflate
the tourniquet, but did reopen his previous incision. We did have some
fluid present in the area, which we sent for cultures, also took some
tissue samples and also swabbed the area in multiple spots. There was no
gross pus present, just a little bit of some fluid. We then very carefully
dissected out his previously placed allograft and we felt that it was
possible he was having reaction to the allograft and/or has an indolent
infection that has been culture negative, but I talked to him
preoperatively, and he preferred to have the allograft tendon removed and
replaced with autograft, which was very reasonable. We very carefully
again dissected out the tendon. It had a significant amount of scar tissue
around it. We were very careful dissecting it down to the tuberosity. Down
at the tuberosity, there was some heterotopic ossification that had
developed that we removed. We carefully kept the forearm supinated to
protect the posterior interosseous nerve. We did remove the allograft. We
left some of it in the actual distal biceps at the musculotendinous
junction, so we did have a tendon to fixate the autograft to. We
identified the tuberosity. We removed some sutures present in the previous
tendon as well, again debrided down to the tuberosity and then we used two
suture anchors, placed one more proximally to the tuberosity at the
proximal aspect of the tuberosity and secured the one end of the tendon to
the bone in that area. We then weaved it through the distal biceps to the
musculotendinous junction, secured it at appropriate tension and then
brought he other limb down and secured it with a PushLock anchor, and felt
we had good tension. We then used the extra part of the graft and weaved
it one more time through the distal portion of the tendon to get a good
graft present. We then deflated the tourniquet and achieved good
hemostasis. We irrigated it again multiple times and made sure we debrided
all potential sources of infection areas and then closed the incision and
placed him into a posterior mold splint. He tolerated the procedure well
and was transferred to recovery room in stable condition.