Deanine
New
PREOPERATIVE DIAGNOSIS(ES): Dehiscences of the left knee wound.
POSTOPERATIVE DIAGNOSIS(ES): Dehiscences of the left knee wound.
OPERATION: Irrigation and debridement the soft tissue repair and closure of
the left knee wound.
INDICATIONS FOR SURGERY: This 83-year-old female was about 3 weeks after
revision of her total knee replacement. Patient developed some dehiscence in
the wound with a small amount of drainage, with no redness around the
incision.
DESCRIPTION OF PROCEDURE: With the patient on the OR table, under general
anesthesia, the dressing was removed. The wound was assessed. Several
cultures were taken, deep and superficial, and were submitted for aerobic and
anaerobic Gram stain examination. Following that, intravenous antibiotic was
administered and the leg was prepped and draped in a sterile fashion. Time-
out was called. The patient was identified and the surgical site was
confirmed. Risk factors and allergies were discussed. As I stated earlier,
intravenous antibiotic was administered and we then extended the wound a
little bit proximally to get into some healthy tissues by blunt dissection.
The skin was separated from subcutaneous tissues and I realized that the
defect was actually in the capsule repair medially. We mobilized some of the
capsule medially and since we did have reasonable tissue laterally, I thought
we will be able to repair it snugly. We then used a pressure irrigation
system and we used a little bit over a liter of the antibiotic solution with
the pressure irrigation system to irrigate the wound. Once irrigation was
completed, we used the #2 FiberWire suture to repair the capsule, which
actually came together very nicely. We then irrigated the wound with the
pressure irrigation system one more time and used subcutaneous 0 Vicryl
sutures to approximate the skin. Following that, we used the 0 nylon type
suture to close the skin with multiple interrupted sutures in a vertical
mattress fashion. A very good repair was obtained. There was no drainage
coming from the wound. Aquacel dressing was applied. The patient was then
awakened and extubated in the operating room and moved to the recovery room
in satisfactory condition, tolerating the procedure well.
POSTOPERATIVE DIAGNOSIS(ES): Dehiscences of the left knee wound.
OPERATION: Irrigation and debridement the soft tissue repair and closure of
the left knee wound.
INDICATIONS FOR SURGERY: This 83-year-old female was about 3 weeks after
revision of her total knee replacement. Patient developed some dehiscence in
the wound with a small amount of drainage, with no redness around the
incision.
DESCRIPTION OF PROCEDURE: With the patient on the OR table, under general
anesthesia, the dressing was removed. The wound was assessed. Several
cultures were taken, deep and superficial, and were submitted for aerobic and
anaerobic Gram stain examination. Following that, intravenous antibiotic was
administered and the leg was prepped and draped in a sterile fashion. Time-
out was called. The patient was identified and the surgical site was
confirmed. Risk factors and allergies were discussed. As I stated earlier,
intravenous antibiotic was administered and we then extended the wound a
little bit proximally to get into some healthy tissues by blunt dissection.
The skin was separated from subcutaneous tissues and I realized that the
defect was actually in the capsule repair medially. We mobilized some of the
capsule medially and since we did have reasonable tissue laterally, I thought
we will be able to repair it snugly. We then used a pressure irrigation
system and we used a little bit over a liter of the antibiotic solution with
the pressure irrigation system to irrigate the wound. Once irrigation was
completed, we used the #2 FiberWire suture to repair the capsule, which
actually came together very nicely. We then irrigated the wound with the
pressure irrigation system one more time and used subcutaneous 0 Vicryl
sutures to approximate the skin. Following that, we used the 0 nylon type
suture to close the skin with multiple interrupted sutures in a vertical
mattress fashion. A very good repair was obtained. There was no drainage
coming from the wound. Aquacel dressing was applied. The patient was then
awakened and extubated in the operating room and moved to the recovery room
in satisfactory condition, tolerating the procedure well.