DButcher
Contributor
Does Anyone have any thoughts on how to code this? I am completely lost. Any help is greatly appreciated!
Preoperative Diagnosis:
1. Compartment syndrome paraspinal
*
Postoperative Diagnosis: same as above
*
Procedure(s):
1. Stryker compartment measuring
2. Fascia compartment release left and right dorsal paraspinal muscle
3. Debridement of dead muscle (deep)
4. Woundvac placmeent
*
OPERATIVE COURSE:
The patient was brought into the Operating Room and upon reaching the
Operating Room, the patient underwent general anesthesia without any
complications.
*
Next, I identified the skin marking and a time out was performed. The
patient was prepped and draped in the usual sterile fashion. Antibiotics
were present. DVT prophylaxis were present.
*
We checked compartment pressure. The left was 90 mmhg and 85 mg while diastolic pressure was 75 mmhg.
*
The right was 40 and 35 mm Hg.
*
Next, the skin was incised. Two paraspinal incision were made. The left we got the fascia. We released the fascia and the muscle did swell somewhat. We kept releasing fascia till we were confident the muscle was released. We check the muscle, the deep muscles seemed necrotic so we debrided the dead tissue.
*
Next we di the same on the right. The musce was more pale and white and did not contract. We did not have much swelling of the muscle. We debrided deep any dead muscle.
We irrigated then placed a woundvac over the two wounds,
*
We will re look at the muscle in 3-5 days with wound vac change and possible closure.
Preoperative Diagnosis:
1. Compartment syndrome paraspinal
*
Postoperative Diagnosis: same as above
*
Procedure(s):
1. Stryker compartment measuring
2. Fascia compartment release left and right dorsal paraspinal muscle
3. Debridement of dead muscle (deep)
4. Woundvac placmeent
*
OPERATIVE COURSE:
The patient was brought into the Operating Room and upon reaching the
Operating Room, the patient underwent general anesthesia without any
complications.
*
Next, I identified the skin marking and a time out was performed. The
patient was prepped and draped in the usual sterile fashion. Antibiotics
were present. DVT prophylaxis were present.
*
We checked compartment pressure. The left was 90 mmhg and 85 mg while diastolic pressure was 75 mmhg.
*
The right was 40 and 35 mm Hg.
*
Next, the skin was incised. Two paraspinal incision were made. The left we got the fascia. We released the fascia and the muscle did swell somewhat. We kept releasing fascia till we were confident the muscle was released. We check the muscle, the deep muscles seemed necrotic so we debrided the dead tissue.
*
Next we di the same on the right. The musce was more pale and white and did not contract. We did not have much swelling of the muscle. We debrided deep any dead muscle.
We irrigated then placed a woundvac over the two wounds,
*
We will re look at the muscle in 3-5 days with wound vac change and possible closure.
