kellit21
Guru
I need help coding this procedure... any information will be greatly appreciated!!!
1. Decompression of posterior aspect of right subtalar joint with removal of the malunited portion of the posterior talus and debridement of the joint.
2. Flexor hallucis longus tendon release and debridement
Description:
An incision was made halfway between the posterior margin of the medial malleolus and the medial margin of the achilles tendon. It was notable that there was significant dense bulging in this area. It was felt to be from the malunited fracture. Abundant overlying venous varicosities were cauterized as we went along. Ultimately, because of the engorgement arounf the neurovascular bundle, again I think part of his impingement, we went ahead and identified the flexor digitorum longus tendon and then worked from there posteriorly keeping the neurovascular bundle, carefully retracted posteriorly and quite gently. Once we made it down to the posterior process of the talus, we subperiosteally dissected back to the FHL tendon which was identified and released from its groove. The tendon itself was in reasonable condition at this level, but notably inflamed in thesheath. The posterior process of the talus was ultimately removed using chisels. We then inspected the posterior aspect of the subtalar joint. The articular surface was somewhat thin, but actullay no exposed bony surface was seen in this small area. The total size fragment removed was 2 x 3 cm. Wound irrigated. Platelet gel was distributed to deep and superficial layers. We did not repair the retinaculum because of the engorgement around the neurovascular bundle and try to decrease the risk of scar contracture.
1. Decompression of posterior aspect of right subtalar joint with removal of the malunited portion of the posterior talus and debridement of the joint.
2. Flexor hallucis longus tendon release and debridement
Description:
An incision was made halfway between the posterior margin of the medial malleolus and the medial margin of the achilles tendon. It was notable that there was significant dense bulging in this area. It was felt to be from the malunited fracture. Abundant overlying venous varicosities were cauterized as we went along. Ultimately, because of the engorgement arounf the neurovascular bundle, again I think part of his impingement, we went ahead and identified the flexor digitorum longus tendon and then worked from there posteriorly keeping the neurovascular bundle, carefully retracted posteriorly and quite gently. Once we made it down to the posterior process of the talus, we subperiosteally dissected back to the FHL tendon which was identified and released from its groove. The tendon itself was in reasonable condition at this level, but notably inflamed in thesheath. The posterior process of the talus was ultimately removed using chisels. We then inspected the posterior aspect of the subtalar joint. The articular surface was somewhat thin, but actullay no exposed bony surface was seen in this small area. The total size fragment removed was 2 x 3 cm. Wound irrigated. Platelet gel was distributed to deep and superficial layers. We did not repair the retinaculum because of the engorgement around the neurovascular bundle and try to decrease the risk of scar contracture.