This pt is in global period for rotator cuff repair. Can I get some help with the following...
PostOp Dx: Septic bursitis, septic arthritis of the rt shoulder, status post rotator cuff repair.
Procedure: Irrigation and debridement of the rt shoulder.
Pt's right upper extremity was prepped and draped in the usual sterile orthopedic fashion. Skin incision was incised with a #10 blade. The indurated edges were debrided at a millimeter margin with another 15 blade as the flaps were raised medially and laterally. Copious irrigation was performed throughout and a small 5 mm defect in the deltoid was noted. Therefore the complete deltoid was taken down from the acromion once again and elevated. Further purulent material was encountered and fluid cultured. The repair had already pulled away with multiple sutures being involved in caseating type material. All the sutures were removed and the bone rongeured. Articular margins were still maintained. The shoulder had debridement throughout of all the soft tissues including bursa with a sharp dissection as well as rongeurs. Clean margins were noted throughout. Over 3 liters of pulsatile lavage was then irrigated throughout the wound with a long tip placed down to the inferior axillary recess posteriorly anteriorly as well. Clean margins were noted throughout as the deltoid was then reapproximated loosely with 0 PDS suture. Wound was packed open and covered with a sterile dressing.
As always any help will be greatly appreciated!
Cathy
PostOp Dx: Septic bursitis, septic arthritis of the rt shoulder, status post rotator cuff repair.
Procedure: Irrigation and debridement of the rt shoulder.
Pt's right upper extremity was prepped and draped in the usual sterile orthopedic fashion. Skin incision was incised with a #10 blade. The indurated edges were debrided at a millimeter margin with another 15 blade as the flaps were raised medially and laterally. Copious irrigation was performed throughout and a small 5 mm defect in the deltoid was noted. Therefore the complete deltoid was taken down from the acromion once again and elevated. Further purulent material was encountered and fluid cultured. The repair had already pulled away with multiple sutures being involved in caseating type material. All the sutures were removed and the bone rongeured. Articular margins were still maintained. The shoulder had debridement throughout of all the soft tissues including bursa with a sharp dissection as well as rongeurs. Clean margins were noted throughout. Over 3 liters of pulsatile lavage was then irrigated throughout the wound with a long tip placed down to the inferior axillary recess posteriorly anteriorly as well. Clean margins were noted throughout as the deltoid was then reapproximated loosely with 0 PDS suture. Wound was packed open and covered with a sterile dressing.
As always any help will be greatly appreciated!
Cathy
