Lisa A
Networker
I am wanting to use 24136, 20220 & 20605 for the following operative report:
Procedure: Right dorsal forearm extensive exploration, curettage & biopsy of the radius bone, irrigation & debridement of necrotic tissue forearm.
Deatils: ...a 22 gauge needle was used to aspirate 10mL of fluid from the elbow. There did not appear to be any infection in the joint. In a standard dorsal thompson approach to the radius was made with incision in line from the lateral epicondyle down to the radial styloid the entire length of the arm. Skin was incised with a #15 blade after elevating the the upper extremity and elevating the tourniquet to 250 mmHg w/out exsanguinating. The soft tissues were carefully dissected with tenotomy scissors and pickups and the gascia overlying the mobile wad and the ERCB was opened up. This muscle plane was split revealing a supinator which grossly had a dusky apprearance to it. The bare area of bone between the abductor pollices longus and the supinator was identified and found to have a fuzzy type appearance to the bone surface and did not look normal. The abductor pollices longus muscle was explored and found to have a huge pocket of purulence w/in it. When touched with the Bovie, it did not contract. It was excised for being necrotic. Next, the supinator was elevated subperiosteally with the arm full supinated to try and avoid PIN nerve, It was subperiosteally elevated off the entire radius almost all the way to the radial head. Pockets of purulence were found t/out the supinator and deep to the interosseous membrane which was opened up and all of the soft tissues were irrigated. Next., a core biopsy was taken of the bone and the canal of the bone was found to be filled entirely with purulence. This bone was sent for pathology and a trough of the radius approximately 10 cm in length was removed from the dorsal aspectof the bone. Purulence was exhibited all throughout. The intramedullary canal was curetted out, pulse lavagesd, irrigated the radius both proximally and distally.
Am I missing anything? I feel like I am!! Thanks in advance for your help!
Procedure: Right dorsal forearm extensive exploration, curettage & biopsy of the radius bone, irrigation & debridement of necrotic tissue forearm.
Deatils: ...a 22 gauge needle was used to aspirate 10mL of fluid from the elbow. There did not appear to be any infection in the joint. In a standard dorsal thompson approach to the radius was made with incision in line from the lateral epicondyle down to the radial styloid the entire length of the arm. Skin was incised with a #15 blade after elevating the the upper extremity and elevating the tourniquet to 250 mmHg w/out exsanguinating. The soft tissues were carefully dissected with tenotomy scissors and pickups and the gascia overlying the mobile wad and the ERCB was opened up. This muscle plane was split revealing a supinator which grossly had a dusky apprearance to it. The bare area of bone between the abductor pollices longus and the supinator was identified and found to have a fuzzy type appearance to the bone surface and did not look normal. The abductor pollices longus muscle was explored and found to have a huge pocket of purulence w/in it. When touched with the Bovie, it did not contract. It was excised for being necrotic. Next, the supinator was elevated subperiosteally with the arm full supinated to try and avoid PIN nerve, It was subperiosteally elevated off the entire radius almost all the way to the radial head. Pockets of purulence were found t/out the supinator and deep to the interosseous membrane which was opened up and all of the soft tissues were irrigated. Next., a core biopsy was taken of the bone and the canal of the bone was found to be filled entirely with purulence. This bone was sent for pathology and a trough of the radius approximately 10 cm in length was removed from the dorsal aspectof the bone. Purulence was exhibited all throughout. The intramedullary canal was curetted out, pulse lavagesd, irrigated the radius both proximally and distally.
Am I missing anything? I feel like I am!! Thanks in advance for your help!