Allysaloop
Contributor
Hello all! I am wondering if anyone can help me understand this note from Practicode? For some reason my brain can't wrap around this one. According to Practicode, the correct primary diagnosis is S68.123A, but I can't figure out why. Is anyone willing to spell this out for me? Thank you very much in advance! 
OPERATIVE REPORT
AGE: 52 Sex: M
Date of Service: 1/1/20XX
Orthopedic Group General
Dr. Brandon Andrews
PREOPERATIVE DIAGNOSIS: Left middle fingertip amputation with exposed bone.
POSTOPERATIVE DIAGNOSIS: Left middle fingertip amputation with exposed bone.
NAME OF PROCEDURES: Reconstruction of left middle finger fingertip with a V-Y advancement flap; Debridement of bone fragment and Placement of full-thickness skin graft form the left antecubital region, size of 0.5 x 1 cm.
SURGEON: Brandon Andrews, MD
ANESTHESIA: General
INDICATIONS: The patient is status post- saw injury to his left hand with a distal tip amputation of this left middle finger. He was seen at Mercy Redding Hospital, where they offered him a revision amputation with shortening and therefore instead came to our Emergency Room for reconstruction. He was admitted overnight and taken to the Operating Room this morning. The risks, benefits, limitations and expected outcomes of surgery were reviewed in detail with the patient, who agreed to proceed with surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the Operating Room, placed supine on the operating table, and was placed under general anesthesia. A well-padded tourniquet was placed on his left upper arm. His left hand and forearm were prepped and draped in a sterile manner. We began by irrigating the wound profusely. We then used the Esmarch to exsanguinate the left hand and forearm to 250 mmHg and then placed the tourniquet to 250 mmHg. We then proceeded to debride a very small amount of nonviable bone that was floating in the wound. We then designed a V-Y flap that extended slightly proximal to the DIP joint. We incised through skin and dermis, and then spread through the fibrous connective tissue. We used a freer over the distal phalangeal bone. We then advanced the flap and closed it over the exposed bone with 5-0 chromic sutures and closed the donor site with 5-0 chromic also. We then harvested a small skin graft from the left antecubital region in full-thickness fashion. We then placed a 0.5 x 1 cm skin graft over the exposed fat portion of the end of the V-Y flap with 5-0 chromic. We then placed bacitracin, Xeroform, dry gauze and then a volar-based splint. He tolerated the procedure well, was awakened from anesthesia without any complication and brought to the Recovery Room in stable condition.
Brandon Andrews, MD
Electronically signed by BRANDON ANDREWS, MD 1/1/20XX
OPERATIVE REPORT
AGE: 52 Sex: M
Date of Service: 1/1/20XX
Orthopedic Group General
Dr. Brandon Andrews
PREOPERATIVE DIAGNOSIS: Left middle fingertip amputation with exposed bone.
POSTOPERATIVE DIAGNOSIS: Left middle fingertip amputation with exposed bone.
NAME OF PROCEDURES: Reconstruction of left middle finger fingertip with a V-Y advancement flap; Debridement of bone fragment and Placement of full-thickness skin graft form the left antecubital region, size of 0.5 x 1 cm.
SURGEON: Brandon Andrews, MD
ANESTHESIA: General
INDICATIONS: The patient is status post- saw injury to his left hand with a distal tip amputation of this left middle finger. He was seen at Mercy Redding Hospital, where they offered him a revision amputation with shortening and therefore instead came to our Emergency Room for reconstruction. He was admitted overnight and taken to the Operating Room this morning. The risks, benefits, limitations and expected outcomes of surgery were reviewed in detail with the patient, who agreed to proceed with surgery.
DESCRIPTION OF PROCEDURE: The patient was brought to the Operating Room, placed supine on the operating table, and was placed under general anesthesia. A well-padded tourniquet was placed on his left upper arm. His left hand and forearm were prepped and draped in a sterile manner. We began by irrigating the wound profusely. We then used the Esmarch to exsanguinate the left hand and forearm to 250 mmHg and then placed the tourniquet to 250 mmHg. We then proceeded to debride a very small amount of nonviable bone that was floating in the wound. We then designed a V-Y flap that extended slightly proximal to the DIP joint. We incised through skin and dermis, and then spread through the fibrous connective tissue. We used a freer over the distal phalangeal bone. We then advanced the flap and closed it over the exposed bone with 5-0 chromic sutures and closed the donor site with 5-0 chromic also. We then harvested a small skin graft from the left antecubital region in full-thickness fashion. We then placed a 0.5 x 1 cm skin graft over the exposed fat portion of the end of the V-Y flap with 5-0 chromic. We then placed bacitracin, Xeroform, dry gauze and then a volar-based splint. He tolerated the procedure well, was awakened from anesthesia without any complication and brought to the Recovery Room in stable condition.
Brandon Andrews, MD
Electronically signed by BRANDON ANDREWS, MD 1/1/20XX
