CodingMom2
Networker
PROCEDURES PERFORMED:
1. Trapezius advancement flap closure of back x 2
2. Excisional debridement measuring 14 x 6 cm skin, soft tissue, muscle, fascia and bone.
3. Adjacent tissue transfer 20 x 15 cm upper back.
4. Bilateral paraspinal muscle advancement flaps
DESCRIPTION OF PROCEDURE:
After informed consent was verified, the patient was taken to the operating room. Preoperative
antibiotics were administered and sequential compression devices were placed on bilateral lower
extremities. General endotracheal anesthesia was induced without difficulty and the patient was then
placed in a prone position. The skin was clipped of all hair, prepped and draped in usual sterile
fashion. Timeout among operating room staff was then performed. The existing wound was
completely debrided of all devitalized tissue and copious irrigation with warm normal saline was
performed. The midline skin was then incised proximally and distally through the subcutaneous
tissue down to the paraspinal muscle fascia and elevated in the suprafascial plane bilaterally to allow
mobilization of this layer to the midline without tension. The paraspinal muscles were identified by
incising the thoracolumbar fascia. Then, we debrided the spinous processes, which were prominent
with rongeurs. I released the paraspinal muscles laterally to allow these to fall over the spinous
processes. This was done bilaterally with figure-of-eight 0 Vicryl sutures. This was reapproximated
without any tension. Then, I elevated the skin and soft tissue flaps off of the trapezius muscle and
further release the trapezius muscles to allow tension-free repair in the midline. This was done
bilaterally and the trapezius flaps were released and reapproximated in the midline using 0 Vicryl
suture. I continued to obtain meticulous hemostasis and elevating the skin soft tissue flaps
lateraly. One 19-French JP drain was used to run between the skin and soft tissue as well as
underneath the trapezius flaps. Once this was done, once again the wound was copiously irrigated.
The skin soft tissue flaps were advanced and the superficial fascial system was reapproximated
with 0 Vicryl sutures Then, 3-0 Monocryl sutures were used for interrupted deep dermal layer.
Then, a 2-0 Prolene suture was used to reapproximate the skin. The drain was sutured into place
with a 2-0 nylon suture. Biopatch and Tegaderm dressings were applied to the drain site. All
instrument, sponge and needle counts were correct. The patient was taken to the postoperative
anesthesia unit in stable dentition. Neck brace was applied.
1. Trapezius advancement flap closure of back x 2
2. Excisional debridement measuring 14 x 6 cm skin, soft tissue, muscle, fascia and bone.
3. Adjacent tissue transfer 20 x 15 cm upper back.
4. Bilateral paraspinal muscle advancement flaps
DESCRIPTION OF PROCEDURE:
After informed consent was verified, the patient was taken to the operating room. Preoperative
antibiotics were administered and sequential compression devices were placed on bilateral lower
extremities. General endotracheal anesthesia was induced without difficulty and the patient was then
placed in a prone position. The skin was clipped of all hair, prepped and draped in usual sterile
fashion. Timeout among operating room staff was then performed. The existing wound was
completely debrided of all devitalized tissue and copious irrigation with warm normal saline was
performed. The midline skin was then incised proximally and distally through the subcutaneous
tissue down to the paraspinal muscle fascia and elevated in the suprafascial plane bilaterally to allow
mobilization of this layer to the midline without tension. The paraspinal muscles were identified by
incising the thoracolumbar fascia. Then, we debrided the spinous processes, which were prominent
with rongeurs. I released the paraspinal muscles laterally to allow these to fall over the spinous
processes. This was done bilaterally with figure-of-eight 0 Vicryl sutures. This was reapproximated
without any tension. Then, I elevated the skin and soft tissue flaps off of the trapezius muscle and
further release the trapezius muscles to allow tension-free repair in the midline. This was done
bilaterally and the trapezius flaps were released and reapproximated in the midline using 0 Vicryl
suture. I continued to obtain meticulous hemostasis and elevating the skin soft tissue flaps
lateraly. One 19-French JP drain was used to run between the skin and soft tissue as well as
underneath the trapezius flaps. Once this was done, once again the wound was copiously irrigated.
The skin soft tissue flaps were advanced and the superficial fascial system was reapproximated
with 0 Vicryl sutures Then, 3-0 Monocryl sutures were used for interrupted deep dermal layer.
Then, a 2-0 Prolene suture was used to reapproximate the skin. The drain was sutured into place
with a 2-0 nylon suture. Biopatch and Tegaderm dressings were applied to the drain site. All
instrument, sponge and needle counts were correct. The patient was taken to the postoperative
anesthesia unit in stable dentition. Neck brace was applied.