ksb0211
Guest
Thanks for any help or suggestions for this one. The patient had a carotid endarterectomy. Later in the day, this was performed.
PREOPERATIVE DIAGNOSIS
Postoperative hematoma status post left carotid endarterectomy.
POSTOPERATIVE DIAGNOSIS
Small bleeder in the platysma.
OPERATION PERFORMED
Exploration of left neck for hematoma with drainage and ligation of small arterial bleeders.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room after attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion. Made an incision, removed the drain, reprepped and then opened the wound, got a little bit of a rush of blood but as we went in looking around, we did not see anything. The endarterectomy site was fine. There was no bleeding deep in the wound. We irrigated and saw that there was a stream of blood coming from the platysma behind as it turned out our "wheat" Lander clamp, pulled that away and we see there was an arterial bleeder there it. We put some 3-0 Vicryl sutures into that, got it stopped in its entirety, irrigated again watch the wound. There was absolutely no further bleeding. This clearly was the site. We irrigated, aspirated, placed another 7 mm drain, then closed with deep sutures of 3-0 Vicryl followed by skin staples and injection with Marcaine. The patient tolerated the procedure quite well.
PREOPERATIVE DIAGNOSIS
Postoperative hematoma status post left carotid endarterectomy.
POSTOPERATIVE DIAGNOSIS
Small bleeder in the platysma.
OPERATION PERFORMED
Exploration of left neck for hematoma with drainage and ligation of small arterial bleeders.
DESCRIPTION OF PROCEDURE
The patient was brought to the operating room after attainment of sufficient general anesthesia, he was pretreated with antibiotics and prepped and draped in the usual sterile fashion. Made an incision, removed the drain, reprepped and then opened the wound, got a little bit of a rush of blood but as we went in looking around, we did not see anything. The endarterectomy site was fine. There was no bleeding deep in the wound. We irrigated and saw that there was a stream of blood coming from the platysma behind as it turned out our "wheat" Lander clamp, pulled that away and we see there was an arterial bleeder there it. We put some 3-0 Vicryl sutures into that, got it stopped in its entirety, irrigated again watch the wound. There was absolutely no further bleeding. This clearly was the site. We irrigated, aspirated, placed another 7 mm drain, then closed with deep sutures of 3-0 Vicryl followed by skin staples and injection with Marcaine. The patient tolerated the procedure quite well.