Is this simply reported as an I&D 10060?
Operation
Right thumb incision and drainage with irrigation and debridement to the level of periosteum
Surgeon(s)
James Phillips D.O.
Assistant
None
Anesthesia
General
Estimated Blood Loss
10 mL
Findings
Patient had significant amount of purulence material within the superficial tension blister with direct communication on the volar ulnar aspect of the thumb pad to an area of necrotic and a vascular tissue that involved the epidermis and dermis. This was deemed to be nonviable and due to the risk of worsening infection and necrosis this area was excised. This overall with approximately 1 x 1.5 cm. The flexor tendon sheath was visualized and found to be intact with no evidence of infection involving the flexor tendon or sheath.
Specimen(s)
Necrotic tissue for pathology as well as cultures x4.
Complications
None
Technique
Patient was seen in the preoperative holding area. The correct operative site was marked. Verbal and written consent was obtained. He was transferred to the operative suite and placed supine on the operating table. Bony prominences well padded. The right upper extremity was then prepped and draped in normal sterile fashion and a time-out was performed with all those in attendance in agreement correct operative site and procedure to be performed.
A 15 blade scalpel used to incise through the superficial blister and skin with care being taken on the depth of incision to avoid damaging the ulnar digital neurovascular structures. Blunt dissection was then undertaken until the level of the abscess was found this was found to track down to the periosteum more proximally. Thorough debridement was undertaken utilizing sharp and blunt mass had. The area of the necrotic skin over the volar and ulnar thumb was divided and then excised after it was deemed to be nonviable. Blunt dissection was taken to the flexor tendon sheath and this was visualized and found to have no fluid collection or appreciable purulence. The deep fascial layers were found to be intact and there was a small subdermal abscess tracking proximally and dorsally. A curette was used to thoroughly debride this area as well as the tissue surrounding the abscess. Once nonviable necrotic tissue was removed as well as the purulence material, 3 L of sterile saline was thoroughly irrigated under gravity pressure throughout the wound as well as the track of the abscess. A single 2 0 nylon stitch was placed to reapproximate the incised area at the level of the excised skin to stabilize the flap. Iodoform packing was then placed followed by wet to dry dressings.
The thumb was well perfused at the end of the procedure with brisk cap refill. Hemostasis was maintained with direct pressure and electrocautery. The patient was woken from anesthesia and transferred to the PACU in stable condition. All needle and scrubbed counts were correct in the case x2.
Operation
Right thumb incision and drainage with irrigation and debridement to the level of periosteum
Surgeon(s)
James Phillips D.O.
Assistant
None
Anesthesia
General
Estimated Blood Loss
10 mL
Findings
Patient had significant amount of purulence material within the superficial tension blister with direct communication on the volar ulnar aspect of the thumb pad to an area of necrotic and a vascular tissue that involved the epidermis and dermis. This was deemed to be nonviable and due to the risk of worsening infection and necrosis this area was excised. This overall with approximately 1 x 1.5 cm. The flexor tendon sheath was visualized and found to be intact with no evidence of infection involving the flexor tendon or sheath.
Specimen(s)
Necrotic tissue for pathology as well as cultures x4.
Complications
None
Technique
Patient was seen in the preoperative holding area. The correct operative site was marked. Verbal and written consent was obtained. He was transferred to the operative suite and placed supine on the operating table. Bony prominences well padded. The right upper extremity was then prepped and draped in normal sterile fashion and a time-out was performed with all those in attendance in agreement correct operative site and procedure to be performed.
A 15 blade scalpel used to incise through the superficial blister and skin with care being taken on the depth of incision to avoid damaging the ulnar digital neurovascular structures. Blunt dissection was then undertaken until the level of the abscess was found this was found to track down to the periosteum more proximally. Thorough debridement was undertaken utilizing sharp and blunt mass had. The area of the necrotic skin over the volar and ulnar thumb was divided and then excised after it was deemed to be nonviable. Blunt dissection was taken to the flexor tendon sheath and this was visualized and found to have no fluid collection or appreciable purulence. The deep fascial layers were found to be intact and there was a small subdermal abscess tracking proximally and dorsally. A curette was used to thoroughly debride this area as well as the tissue surrounding the abscess. Once nonviable necrotic tissue was removed as well as the purulence material, 3 L of sterile saline was thoroughly irrigated under gravity pressure throughout the wound as well as the track of the abscess. A single 2 0 nylon stitch was placed to reapproximate the incised area at the level of the excised skin to stabilize the flap. Iodoform packing was then placed followed by wet to dry dressings.
The thumb was well perfused at the end of the procedure with brisk cap refill. Hemostasis was maintained with direct pressure and electrocautery. The patient was woken from anesthesia and transferred to the PACU in stable condition. All needle and scrubbed counts were correct in the case x2.