vmccoy2979
New
- Messages
- 1
- Best answers
- 0
right thigh cellulitis
2. Myositis multiple muscles in the right leg
3. Possible fasciitis of the right leg
Post-Operative Diagnosis:
1. Right thigh cellulitis
2. Myositis multiple muscles in the right leg
3. Possible fasciitis of the right leg
Procedure
1. Incision and drainage of the right leg down to the level of the muscle
Surgical Team
Surgeon: Dustin S Campbell
Anesthesiologist/CRNA: Eric L Herrell
Anesthesia
Anesthesia Type: IV Sedation, Local and Spinal
Blood Loss
Blood Loss: estimated (5 milliliters)
Specimen/Pathology
Specimen/Pathology: other (Cultures)
Implants/Drains/Implanted Tissue
Implants/Drains/Implanted Tissue: None
Complications
Complications: No
Operative Indications
Michael is a 47-year-old gentleman who was admitted to the hospital on April 9th after a drug overdose, he is unable to provide any significant history as to what happened during that time. It appears he signed out of the hospital on April 10th and then re-presented back through the emergency department due to leg pain and blisters on the same day. I was consulted today after an MRI of the right hip revealed myositis, possible fasciitis. He had a rather large area a proximally 20+ centimeters of cellulitis on his right thigh, this had been marked by the nursing staff earlier in the day, by the evening, this area was well outside of the original marking and was felt to be worse. Given the concern for fasciitis and the inability to get him to a tertiary care facility the decision was made to come to the operating room to evaluate for possible fasciitis. I discussed with him the risks and benefits and he was agreeable to proceed.
Operative Findings
Three incisions were made on the right thigh, upper middle and lower. These were generous incisions to allow for evaluation of the underlying musculature. The middle incision had the most edematous and dark colored musculature, there was no evidence of ischemia or purulent drainage. There was no dishwater edema. The lowest and the most upper incisions had normal appearing musculature. Once again there was no purulence or discolored fluid encountered.
Cultures were taken of the middle incision into the fascia and musculature.
Operative Description
Informed consent was obtained, patient was brought to the operating room, anesthesia placed a spinal. After appropriate anesthesia, he was placed in left lateral position, his right leg was prepped and draped in the usual sterile fashion. A time-out was performed. Made an incision in the middle portion of the thigh, this was the most indurated area of cellulitis. This incision measured about 3 inches. This was carried down through the fatty tissue, there was lots of edema, but no discolored fluid, no purulent fluid. This was carried down to the fascia of the musculature, the fascia was opened, there was some darkness of the muscle, I would not consider this ischemic, but did appear unhealthy. Cultures were obtained along the fascia and on the muscle. Two additional incisions were made at the top of the thigh and toward the bottom of the thigh closer to the knee. These were generous enough incisions to allow for opening of the fascia and evaluation muscle. This muscle appeared normal. Given the extensiveness of the edema the decision was made to leave all three incisions opened. Incisions were irrigated. A moist dressing was placed in each and they were covered with ABD pads. He will be transferred back to the floor, continue IV antibiotics.
2. Myositis multiple muscles in the right leg
3. Possible fasciitis of the right leg
Post-Operative Diagnosis:
1. Right thigh cellulitis
2. Myositis multiple muscles in the right leg
3. Possible fasciitis of the right leg
Procedure
1. Incision and drainage of the right leg down to the level of the muscle
Surgical Team
Surgeon: Dustin S Campbell
Anesthesiologist/CRNA: Eric L Herrell
Anesthesia
Anesthesia Type: IV Sedation, Local and Spinal
Blood Loss
Blood Loss: estimated (5 milliliters)
Specimen/Pathology
Specimen/Pathology: other (Cultures)
Implants/Drains/Implanted Tissue
Implants/Drains/Implanted Tissue: None
Complications
Complications: No
Operative Indications
Michael is a 47-year-old gentleman who was admitted to the hospital on April 9th after a drug overdose, he is unable to provide any significant history as to what happened during that time. It appears he signed out of the hospital on April 10th and then re-presented back through the emergency department due to leg pain and blisters on the same day. I was consulted today after an MRI of the right hip revealed myositis, possible fasciitis. He had a rather large area a proximally 20+ centimeters of cellulitis on his right thigh, this had been marked by the nursing staff earlier in the day, by the evening, this area was well outside of the original marking and was felt to be worse. Given the concern for fasciitis and the inability to get him to a tertiary care facility the decision was made to come to the operating room to evaluate for possible fasciitis. I discussed with him the risks and benefits and he was agreeable to proceed.
Operative Findings
Three incisions were made on the right thigh, upper middle and lower. These were generous incisions to allow for evaluation of the underlying musculature. The middle incision had the most edematous and dark colored musculature, there was no evidence of ischemia or purulent drainage. There was no dishwater edema. The lowest and the most upper incisions had normal appearing musculature. Once again there was no purulence or discolored fluid encountered.
Cultures were taken of the middle incision into the fascia and musculature.
Operative Description
Informed consent was obtained, patient was brought to the operating room, anesthesia placed a spinal. After appropriate anesthesia, he was placed in left lateral position, his right leg was prepped and draped in the usual sterile fashion. A time-out was performed. Made an incision in the middle portion of the thigh, this was the most indurated area of cellulitis. This incision measured about 3 inches. This was carried down through the fatty tissue, there was lots of edema, but no discolored fluid, no purulent fluid. This was carried down to the fascia of the musculature, the fascia was opened, there was some darkness of the muscle, I would not consider this ischemic, but did appear unhealthy. Cultures were obtained along the fascia and on the muscle. Two additional incisions were made at the top of the thigh and toward the bottom of the thigh closer to the knee. These were generous enough incisions to allow for opening of the fascia and evaluation muscle. This muscle appeared normal. Given the extensiveness of the edema the decision was made to leave all three incisions opened. Incisions were irrigated. A moist dressing was placed in each and they were covered with ABD pads. He will be transferred back to the floor, continue IV antibiotics.