KristinM522
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Hello!
I need some help coding the local rotational flap closure. I know I need more information (size) but I've never coded this before and not exactly sure how the procedure goes or if Doc did the whole procedure. I'm really hoping someone can help me figure it out! Thank you in advance!!
POSTOPERATIVE DIAGNOSES:
1. Recalcitrant plantar ulceration, left heel.
2. Diabetes with neuropathy.
3. History of Charcot deformity.
OPERATION PERFORMED:
1. Partial calcanectomy, left.
2. Local rotational flap closure, left heel (O to TOZ flap).
PROCEDURE IN DETAIL:
The patient identified by name and consented for the
above-mentioned procedures. Brought into the operating room,
received a spinal anesthetic, and was carefully placed in the
prone position, well-padded and protected on the operating room
table. The tourniquet had been applied to well-padded left thigh.
The left lower extremity was scrubbed, prepped, and draped in the
usual sterile fashion. After appropriate time-out, the left lower
extremity was exsanguinated, the tourniquet was inflated. The
ulcer was excised with a #10-blade, circumferentially down to
bone. The extensions of the Z for the O- Z closure were drawn out
and then incised with a #10 blade. Handling of the flaps was
avoided by placing 2-0 silk through each one with a hemostat to
help retract gently. Once this was satisfactorily completed, the
soft tissues adhered to the calcaneus and the area were sharply
excised.
Next, using a combination of curved and straight osteotomes,
partial calcanectomy was performed, resecting the plantar portion
of the calcaneus and around the tuberosity to offload the plantar
fat pad. The margins were completed as well with a sagittal saw
and then osteotomes if needed. All this bone was excised. It was
firm and appeared viable, and was sent for pathology. Once
satisfactorily resected, the area was smoothed down with a power
rasp, followed by a copious repetitive irrigation with antibiotic
saline solution. The area was cleansed and dried. Bone wax was
placed over the resected remaining portion of the calcaneus. Once
this was completed, the flap was closed covering the deficit using
a #0 silk sutures. Apical stitches were used to close the
corners. Tourniquet was deflated. Capillary fill time was brisk.
Note that prior to closure, a TLS drain had been inserted and this
was patent upon final closure as a drain. The foot was cleansed
and dried, dressed with Xeroform, 4x4, then Kerlix and Coban from
the toes to the knee. The patient tolerated the procedures and
anesthesia well, left the operating room with vital signs stable,
vascular status intact to all digits of the left foot.
I need some help coding the local rotational flap closure. I know I need more information (size) but I've never coded this before and not exactly sure how the procedure goes or if Doc did the whole procedure. I'm really hoping someone can help me figure it out! Thank you in advance!!
POSTOPERATIVE DIAGNOSES:
1. Recalcitrant plantar ulceration, left heel.
2. Diabetes with neuropathy.
3. History of Charcot deformity.
OPERATION PERFORMED:
1. Partial calcanectomy, left.
2. Local rotational flap closure, left heel (O to TOZ flap).
PROCEDURE IN DETAIL:
The patient identified by name and consented for the
above-mentioned procedures. Brought into the operating room,
received a spinal anesthetic, and was carefully placed in the
prone position, well-padded and protected on the operating room
table. The tourniquet had been applied to well-padded left thigh.
The left lower extremity was scrubbed, prepped, and draped in the
usual sterile fashion. After appropriate time-out, the left lower
extremity was exsanguinated, the tourniquet was inflated. The
ulcer was excised with a #10-blade, circumferentially down to
bone. The extensions of the Z for the O- Z closure were drawn out
and then incised with a #10 blade. Handling of the flaps was
avoided by placing 2-0 silk through each one with a hemostat to
help retract gently. Once this was satisfactorily completed, the
soft tissues adhered to the calcaneus and the area were sharply
excised.
Next, using a combination of curved and straight osteotomes,
partial calcanectomy was performed, resecting the plantar portion
of the calcaneus and around the tuberosity to offload the plantar
fat pad. The margins were completed as well with a sagittal saw
and then osteotomes if needed. All this bone was excised. It was
firm and appeared viable, and was sent for pathology. Once
satisfactorily resected, the area was smoothed down with a power
rasp, followed by a copious repetitive irrigation with antibiotic
saline solution. The area was cleansed and dried. Bone wax was
placed over the resected remaining portion of the calcaneus. Once
this was completed, the flap was closed covering the deficit using
a #0 silk sutures. Apical stitches were used to close the
corners. Tourniquet was deflated. Capillary fill time was brisk.
Note that prior to closure, a TLS drain had been inserted and this
was patent upon final closure as a drain. The foot was cleansed
and dried, dressed with Xeroform, 4x4, then Kerlix and Coban from
the toes to the knee. The patient tolerated the procedures and
anesthesia well, left the operating room with vital signs stable,
vascular status intact to all digits of the left foot.