Abdominal wall bulge following DIEP flap-- reconstruction

igforero

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Good afternoon,

The surgeon performed a bilateral breast revision with fat grafting and a bilateral abdominal wall with stratus, due to abdominal wall bulge following DIEP flap. I would appreciate any help with a code for the abdominal reconstruction.

Below there is an extract of the op report
"...The previous closure was with Ethibond
sutures in the rectus sheath and this was identified and then opened.
Once this was opened, the rectus muscle was then dissected from the
undersurface of the rectus sheath and there was noted to be a
significant split and absence of the medial aspect of the rectus
muscle on the right side. Therefore, dissection was then carried down
on the rectus muscle all the way down to its insertion at the pubic
bone level. The fascia was then delineated laterally and then there
was found to be in the medial aspect an onlay type of material that
was not adherent across the abdominal wall but was rather fitting
isolated the abdominal wall but attached to the muscle. It was
difficult to find the medial border of the rectus sheath anteriorly
throughout and it became apparent that also the medial rectus on the
left side was affected as well. Dissection was then carried out
superiorly to healthy rectus muscle and rectus sheath that had not
been involved in the dissection. Once this was done, a piece of
stratus that measured 16 x 20 and covered the defect, was sewn with 0
Prolene sutures to the pubic tubercle and then running medially to the
undersurface of the anterior rectus sheath and then up superiorly past
the arcuate line to the anterior and posterior rectus sheath.
Laterally, the stratus was then pulled tight and then excess stratus
was trimmed and 0 Prolene suture was then sewn to the lateral fascia
and part of the external oblique with 0 Prolene sutures. The rectus
sheath was then closed with 0 Prolene sutures in a buried figure-of-
eight fashion. Attention was then turned to the left side where there
was a defect that was noted to be in the medial aspect as well. It did
not go down to the pubic tubercle area and this was closed also with
stratus and measuring 8 x 12 cm and again with 0 Prolene sutures.
Here, the fascia was then closed as well. The wound was then irrigated
with antibiotic irrigation and then closed over a Jackson-Pratt drain
with 2-0 Vicryl sutures in the Scarpa's fascia, followed by 3-0
Monocryl suture in buried interrupted fashion in deep dermal layer,
followed by simple 4-0 Monocryl suture.* Before closing the abdominal
wall, it was injected with Klein solution after which using a 4 mm
cannula, fat was then harvested and placed through a Revolve fat
filtration system. This then provided roughly 200 mL of pure fat of
which the inferior aspect of the right breast was then undermined...

thank you
 
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