Wound Vac closure - Sacral Ulcer

mkndevh@msn.com

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Would anyone be able to give me a little guidance on the following procedure? I see the 15931-15933, but these are with primary sutures and surgeon used wound vac for closure. Any ideas? Thank you!

OPERATION
1. Debridement of sacral decubitus ulcer stage IV, 6 x 6 x 2cm.
2. Debridement of right ischial decubitus ulcer stage IV, 10 x4 x2 cm.
3. Wound VAC application

DESCRIPTION OF PROCEDURE
The patient was brought to the operating room in stable condition. She
was placed on the table in the prone position after undergoing smooth
endotracheal intubation. SCDs were on and functional and the patient
had Lovenox on the floor because her Caprini Score indicates that she is at
high risk for postoperative DVT. The patient was prepped and draped in a sterile
fashion. A time out was performed.
*
I first began by excising around the edges of the sacral
decubitus ulcer. I was able to dissect back to good healthy tissue.
The area was debrided and the necrotic muscle was all removed. There was minimal granulation tissue that was also removed. Her sacrum
had some soft bone that was debrided with a rongeur. The sacral tissue
was sent off for culture as a biopsy and the bone was also sent off for
cultures as well. All bleeding was controlled and remained hemostatic.
The wound was irrigated and packed.
*
The right ischial area was then sharply debrided. All necrotic tissue was removed. There was significant muscle necrosis that needed to be debrided as well. A
specimen was sent off for cultures as well. The area was irrigated out
and hemostasis was obtained. This wound was then packed.
*
I then returned my attention to the sacral decubitus area. There
appeared to be no bleeding. The wound measured 6 x 6 x 2 cm. The area
was cleaned and dried. Adaptic and black foam were placed. Then the
wound VAC sticky paper was applied and then a Trackpad was applied.
This was hooked up to a wound VAC and was able to maintain a good seal.
*
The right ischial area was then addressed. The packing was removed and
hemostasis remained excellent. Adaptic and black foam were then placed
in the wound. The wound VAC sticky paper was then applied and a Trackpad was applied.
This was connected to the other wound VAC with a T junction and hooked
up to the VAC canister. A good seal was able to be obtained and there
were no signs of a leak. The surrounding area was cleaned and dried.
The patient was turned over into the supine position and extubated. She
appeared to tolerate the procedure well. She was awake, comfortable, and talking
in the recovery room.
*
 
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