I haven't coded many ortho cases...and sorry this one is soooo long but I was thinking of codes:

26125 x3

PREOPERATIVE DIAGNOSIS: Complex severe degloving crush injury to the right hand, multiple surgeries with residual, palm scar contracture, first, second and third web contracture, long finger flexion contracture, and extensor tendons to the index, long, and ring finger scar adhesions. The index finger extensor tendon ulmarly subluxation becuase of the radial sagittal band dysfunction.


47-year-old female with a complex severe injury to the hand. She has been treated with multiple surgeries with current residual with dificult function of the hand because of: 1) The palm contracture 2) the index finger extensor tendon and ulnar subluxation wth incompetency of the radial sagittal band 3) the right second web contracture, third web contracture, plus the extensor tendon scar adhesions as well as teh long finger flexor contracture. These are indications for surgical intervention to improve the hand function.

Under general sedation and anesthesia, the patient was placed in the suine position on the surgical table. After prep and drape in the regular fashion, first of all we addressed the right palm contracture release. I identified the contracture band and the landmark of the zigzag disegn. Subsequently, after multiple zigs were applied and the contracture was released, which was improved significantly.

Attention was then turned to the index finger radial sagittal band reconstruction and extensor tendon centralization. Staying on the radial portion of the metacarpophalangeal joint o f the index finger, coverage of incision was admitted and further dissection identified the sagittal band on the radial portion with the dysfunction and attenuation. The extensor tendon was ulnarly deviated. At this point, we further dissected to the ulnar side of the metacarpophalangeal joint and released teh contracture of the ulnar sagittal band. Meanwhile we used a surrounding tissue transfer combined with partial extensor tendon transfer and engaged into the volar plate complex. Further, the radial sagittal band was successfully reconstructed. Meantime, the flexion and extension was done without difficulty and maintained the extensor at the central position and adjusted the finger in the tract with flexion/extensio.

Attention was then turned to the second web scar release. At this point because of the significant web space contracture, a V-shaped was advanced to Y-plasty was developed. Meanwhile, we attempted to leave the skin deficit size up to 3.5 cm in length and 1.2 cm wide.
Attention was then turned to the long finger flexor contrcture release. At this point, we develped a Z-plasty in the proximal portion of the long finger correcting the contracture successfully. Then, the middle portion of the digit had partial skin missing and was directly considered for the skin graft.

Attention was then turned to the long finger extensor scar adhesion release. We further dissected in two planes. One plane was above and one plane was below to the tendon with a tendon freer. We fully released the contracture with surrounding the tissue to allow finger flexion/extension passively without significant difficulty.
Attention was then turned to the third web contracture release. A Z-plasty was also developed. We opened the scarring and then subsequently developed the skin deficit around 2.0 cm in length and 1.5 cm wide.
At this point, attention was then turned to the ring finger extensor scar release done in a similar fashion as the long finger. After release of the scarring, the previous bone deformity was significantly improved immediately.
Attention was then turned to the abdominal wall for full thickness skin graft and to cover the second and third web skin deficits, plus the long finger skin deficit. After landmarks of the middle lateral left side of the anterior wall of the abdominal wall, frehand full thickness skin graft was harvested. Te donor site subcutaneous layer was resected and further dissection superiorly and inferiorly to allow the wound to be primarily closed without significant tension.
Attention was then turned to the full thickness skin graft to the second web, to the third web, and to the long finger by the size of the deficit we created. Then the wound sites were packed with Xeroform and further covered the sponge was engaged to compress the fracture site to the base of the wound and to allow the healing.
Attention was then turned to compression ddressings to the web region, the long finger, index finger, and the ring finger. Then, the short arm splint was applied to maintain the metacarpophalangeal joint at the 60-degree flexion position and the wrist joint at the 30-degree flexion position.

After surgery, the patient's viatl signs were stable and she was ready to go to the recovery room.

any help is appreciated!!!!