HELP ! Sharp excisional debridement of chest wound

Messages
165
Location
Greer, SC
Best answers
0
any advice on how to learn to code excisional debridement is appreciated.

13160 or 11042 11045

Procedure:
1. Sharp excisional debridement of chest wound x2 (5x4x2cm + 3x2x2cm)

75 y/o gentleman, s/p CABG several months ago who developed a delayed non-healing wound to the lower pole of his incision. This was ultimately managed with negative pressure wound therapy. Most recent wound cultures returned negative. He returns to the operating room today for dressing change or definitive closure.

Wound Classification:
Clean-contaminated

Findings:
1. Continued granulation tissue at the wound base of each wound with reduction in each cavity
2. No purulence, active drainage or other sign of infection
3. Sternal table stable
4. Each wound was closed separately and primarily over a JP drain, externalized as described below

Procedure Details:
The patient had their history and physical updated prior to the procedure. They were then transferred to the operating suite and placed on the operating table where general anesthesia was affected. Monitoring lines were placed by anesthesia. The patient was then prepped and draped in usual sterile fashion. A surgical timeout was used confirm patient identity as well as the surgery to be performed.

The previously placed wound vac dressing and black sponges were removed. Each of the wound was inspected with findings as described above. Given this, and the resulted negative wound bed cultures obtained several days ago, the decision was made to perform a primary closure of each wound. The wounds were copiously irrigated with Irricept solution. Next, with the aforementioned assistant providing continual retraction and suctioning, the peripheral of each wound was excised sharply with Metzenbaum scissors and scalpel to the dimensions as stated above in order to remove any residual devitalized tissue. Hemostasis was achieved with conservative electrocautery. The wounds were again irrigated with Irricept solution. Next, a 15Fr JP drain was placed and positioned at the base of each wound, superficial to the sternum and fascia, and externalized. Each wound was then closed in layers with interrupted 3-0PDS in the deep dermis and muscular layer. Interrupted 3-0 Nylon sutures were used to close the skin. Sterile dressings were applied.

At this stage, the procedure was discontinued. The patient was subsequently delivered from anesthesia and transferred to the post anesthesia care unit in stable condition having tolerated the procedure well.

Drains:
1. Left JP, chest, inferior wound bed
2. Right JP, chest, superior wound bed
 
Top