lisammy
Guru
I have the following op note and we can not agree here in the office so I am looking for some more opinions. One of us says only bill new fem-fem(35661) and one of us says new fem-fem(35661) and revision of the old one(35879)
Thanks in advance
TECHNIQUE: The patient was brought to the operating, a gram of vancomycin radial A line, Foley catheter placed prior induction of anesthesia. After adequate anesthesia was obtained, the patient was prepped and draped in the usual sterile fashion. The right groin was opened through redo longitudinal incision. The scar was removed. The common femoral artery proximal and distal to the Dacron graft was dissected and vessel loops placed. The left groin was reopened with excision of the necrotic skin with an ellipse in longitudinal fashion. 5000 units of Heparin were given, an additional 1000 was given an hour later. The right common femoral artery was then clamped as well as, the graft. The pseudoaneurysm as opened from the left groin and there was bleeding in the orifice of the common femoral and profunda artery and a #5 Fogarty catheter was used to control the back bleeding. The pseudoaneurysm capsule was then removed bluntly. There was excessive amount of skin after the entire pseudoaneurysm capsule was removed. The Dacron graft was not attached to the left common femoral artery. The entire Dacron graft was removed back to the right common femoral artery and just a rim of Dacron was left. An 8 millimeter ring PTFE
graft was then tunneled from the right groin to the left groin. It was then
spatulated and the PTFE graft was first sewn to the left orifice of the common femoral profunda artery with a running 5-0 Prolene suture. After tunneling the graft above the lax space onto the abdomen it was brought down into the right groin. It was then sewn end to end to the rim of the Dacron graft with a running 5-0 Prolene suture. Clamps were released and there was excellent graft augmented flow in the distal common femoral artery on the left. Interrupted 2-0 Vicryl were used in both groins to close as much soft tissue as possible around the graft as well as over the abdominal wound. A transverse incision had previously been made in the abdomen to help with debriding the pseudocapsule. This wound was then closed with interrupted 2-0 Vicryl to plicate the fascia to the deep fascia. The skin was loosely closed with interrupted 4-0 nylon and a wound vac sponge was placed in the abdominal midline wound. The groin incisions were then closed in layers with running 2-0 and 3-0 Vicryl sutures. Finally the skin was closed with running 3-0 nylon sutures.
Thanks in advance
TECHNIQUE: The patient was brought to the operating, a gram of vancomycin radial A line, Foley catheter placed prior induction of anesthesia. After adequate anesthesia was obtained, the patient was prepped and draped in the usual sterile fashion. The right groin was opened through redo longitudinal incision. The scar was removed. The common femoral artery proximal and distal to the Dacron graft was dissected and vessel loops placed. The left groin was reopened with excision of the necrotic skin with an ellipse in longitudinal fashion. 5000 units of Heparin were given, an additional 1000 was given an hour later. The right common femoral artery was then clamped as well as, the graft. The pseudoaneurysm as opened from the left groin and there was bleeding in the orifice of the common femoral and profunda artery and a #5 Fogarty catheter was used to control the back bleeding. The pseudoaneurysm capsule was then removed bluntly. There was excessive amount of skin after the entire pseudoaneurysm capsule was removed. The Dacron graft was not attached to the left common femoral artery. The entire Dacron graft was removed back to the right common femoral artery and just a rim of Dacron was left. An 8 millimeter ring PTFE
graft was then tunneled from the right groin to the left groin. It was then
spatulated and the PTFE graft was first sewn to the left orifice of the common femoral profunda artery with a running 5-0 Prolene suture. After tunneling the graft above the lax space onto the abdomen it was brought down into the right groin. It was then sewn end to end to the rim of the Dacron graft with a running 5-0 Prolene suture. Clamps were released and there was excellent graft augmented flow in the distal common femoral artery on the left. Interrupted 2-0 Vicryl were used in both groins to close as much soft tissue as possible around the graft as well as over the abdominal wound. A transverse incision had previously been made in the abdomen to help with debriding the pseudocapsule. This wound was then closed with interrupted 2-0 Vicryl to plicate the fascia to the deep fascia. The skin was loosely closed with interrupted 4-0 nylon and a wound vac sponge was placed in the abdominal midline wound. The groin incisions were then closed in layers with running 2-0 and 3-0 Vicryl sutures. Finally the skin was closed with running 3-0 nylon sutures.
