Help coding this one? Would it be 97597 x 1 and 97598 x 5?
Postoperative Diagnosis
Right arm compartment syndrome, no infection, olecranon bursitis
Operation
Right repeat irrigation and debridement of necrotic muscle, open irrigation and re-closure of the carpal tunnel. Placement of KCI wound VAC 17 cm x 8 cm x 0.5 cm.
Surgeon(s)
James Phillips, D.O.
Assistant
Kayla Phillips, APRN
Anesthesia
General
Estimated Blood Loss
25 mL
Findings
The surrounding skin edges demonstrated adequate perfusion and punctate bleeding however there was blanching of the superficial volar musculature with poor reactivity to the the electrocautery and forceps. After debridement of this necrotic muscle there was increased perfusion noted around the muscle. The median nerve and ulnar nerve were visualized and found to have no tension or adverse finding. The skin was not able to be reapproximated and a new wound VAC was applied.
Specimen(s)
None
Complications
None
Technique
The patient was seen in the preoperative holding area. The correct operative site was marked. Verbal and written consent was obtained. He was transferred to the operative suite and placed supine on the operating table. He was given the benefit of general anesthesia by the anesthesia team. The prior wound VAC was then removed and the arm was prepped and draped in a normal sterile fashion. A time-out was performed and all those in attendance were in agreement with the correct operative site and procedure to be performed.
Utilizing the electrocautery and the Adson forceps the muscle was evaluated and focal areas with associated blanching were found to be nonreactive. This area of the muscle mainly of the superficial forearm compartment was sharply debrided utilizing Metzenbaum scissors. The deep compartment was evaluated in the median nerve was visualized and found to be intact with no significant area of compression or abnormal finding. The ulnar nerve was also visualized and found to be intact with no areas of abnormal finding. 3 L of sterile saline were used to irrigate thoroughly the open wound utilizing gravity through cysto tubing. The proximal and distal aspects of the open wound were still quite taut and deemed not amenable to attempted closure. The superficial neurovascular structures were covered with the white foam followed by an appropriately contoured a black foam for repeat wound VAC closure. Once this was placed the carpal tunnel was released and repeat irrigation was performed as well as repeat closure utilizing 2 0 nylon in a horizontal mattress fashion. The wound VAC was then applied and suction obtained with excellent seal noted on the machine.
Xeroform, 4x4s, Ace wrap was then applied over the incision for the carpal tunnel and the prior incision from the olecranon bursectomy. The patient was woken from anesthesia and transferred to PACU in stable condition. All needle and scrubbed counts were correct at the end the case x2.
The services of a 1st assistant ARNP were necessary for this case due to the need for well trained surgical assistance for retractor placement and use. As well as the complex nature of the compartment syndrome making the case more technically demanding. The 1st assistant provided improved visualization throughout the surgery as well as assisted in proper patient positioning and preparation. They also assisted in placement of the wound VAC in order to obtain proper seal.
Postoperative Diagnosis
Right arm compartment syndrome, no infection, olecranon bursitis
Operation
Right repeat irrigation and debridement of necrotic muscle, open irrigation and re-closure of the carpal tunnel. Placement of KCI wound VAC 17 cm x 8 cm x 0.5 cm.
Surgeon(s)
James Phillips, D.O.
Assistant
Kayla Phillips, APRN
Anesthesia
General
Estimated Blood Loss
25 mL
Findings
The surrounding skin edges demonstrated adequate perfusion and punctate bleeding however there was blanching of the superficial volar musculature with poor reactivity to the the electrocautery and forceps. After debridement of this necrotic muscle there was increased perfusion noted around the muscle. The median nerve and ulnar nerve were visualized and found to have no tension or adverse finding. The skin was not able to be reapproximated and a new wound VAC was applied.
Specimen(s)
None
Complications
None
Technique
The patient was seen in the preoperative holding area. The correct operative site was marked. Verbal and written consent was obtained. He was transferred to the operative suite and placed supine on the operating table. He was given the benefit of general anesthesia by the anesthesia team. The prior wound VAC was then removed and the arm was prepped and draped in a normal sterile fashion. A time-out was performed and all those in attendance were in agreement with the correct operative site and procedure to be performed.
Utilizing the electrocautery and the Adson forceps the muscle was evaluated and focal areas with associated blanching were found to be nonreactive. This area of the muscle mainly of the superficial forearm compartment was sharply debrided utilizing Metzenbaum scissors. The deep compartment was evaluated in the median nerve was visualized and found to be intact with no significant area of compression or abnormal finding. The ulnar nerve was also visualized and found to be intact with no areas of abnormal finding. 3 L of sterile saline were used to irrigate thoroughly the open wound utilizing gravity through cysto tubing. The proximal and distal aspects of the open wound were still quite taut and deemed not amenable to attempted closure. The superficial neurovascular structures were covered with the white foam followed by an appropriately contoured a black foam for repeat wound VAC closure. Once this was placed the carpal tunnel was released and repeat irrigation was performed as well as repeat closure utilizing 2 0 nylon in a horizontal mattress fashion. The wound VAC was then applied and suction obtained with excellent seal noted on the machine.
Xeroform, 4x4s, Ace wrap was then applied over the incision for the carpal tunnel and the prior incision from the olecranon bursectomy. The patient was woken from anesthesia and transferred to PACU in stable condition. All needle and scrubbed counts were correct at the end the case x2.
The services of a 1st assistant ARNP were necessary for this case due to the need for well trained surgical assistance for retractor placement and use. As well as the complex nature of the compartment syndrome making the case more technically demanding. The 1st assistant provided improved visualization throughout the surgery as well as assisted in proper patient positioning and preparation. They also assisted in placement of the wound VAC in order to obtain proper seal.