debridement and flap


Wallingford, CT
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im curious to see if im even close with this coding-is the closure billable since flap was not created?
The patient was placed in supine position on the operating table and general inhalation anesthesia was induced. The open right transmetatarsal amputation was prepped with Betadine solution. Sterile drapes were placed and a proper timeout was held. The wound was then aggressively debrided of all necrotic appearing soft tissue on the distal flap down to bleeding healthy soft tissue. Proximally the bones of the transected metatarsals were debrided retrograde utilizing a rongeur. There was bleeding from digital arteries and a dorsal plantar artery which were controlled electrocautery skin edges were then freshened with sharp incisions. The flap was then turned and now would closed against the skin edges without undue tension. Copious irrigation was performed and additional hemostasis as required. "Dog ears" were trimmed on the medial lateral aspect of the suture line. The flap was then closed with simple 3-0 nylon sutures for a tension-free closure. Xeroform 4 x 4's and ABDs Kerlix wrap and an Ace bandage were used for dressing.