I'm at a loss regarding this surgery. I starting to believe I should code this surgery with a 37618 and for placement of antibiotic beads 11981.
Performed Procedure:
1. Excision of SFA and removal of stents
2. Placement of abx beads 20 in total into the wound bed
3. Negative pressure dressing 20 cm wide x 20 cm in length and 15 cm in depth along the AKA stump,
4.Negative pressure dressing to left groin 10 cm length x 2cm width x 1 cm depth
Pre-Operative Diagnosis: infected AKA stump and infected SFA covered stents
Post-Operative Diagnosis: same
Estimated Blood Loss: 75 cc Specimens Removed: SFA and stent for culture, cultures sent Findings: infected SFA just distal to origin with exposed stent just distal to the origin
Operative Report: The patient was taken to the OR for a necrotic wound and was undergoing debridement of his AKA stump noting necrotic muscle and tissue which as debrided by Dr. and he noted purulent drainage from the SFA and I was called into the OR. We extended the medial incision along the sarotorius and mobilized the SFA off the FV. We controlled any bleeding of the FV with a 6-O prolene suture. As we mobilized proximally we noted purulent drainage from the more proximal SFA and noted there was exposed stent. We sent cultures and at this point we opted to take the SFA at the origin to ensure we removed all infected tissue as well as all the covered stents. We then made an longitudinal incision overtop the artery and used electrocuatery to dissect down to the femoral sheath. The inguinal ligament was identified as well as the CFA which was noted to have a posterior plaque. We ascertained circumferential control of the CFA with a vessel loop. We dissected out the SFA and PFA and ascertained circumferential control. We controlled any bleeding with suture ligation and hemoclips. We then heparinized the patient and waited three minutes to allow circulation time. We clamped proximally, the profunda and SFA as well as any branches that we controlled with vessel loops. We then transected the SFA from the origin.
Performed Procedure:
1. Excision of SFA and removal of stents
2. Placement of abx beads 20 in total into the wound bed
3. Negative pressure dressing 20 cm wide x 20 cm in length and 15 cm in depth along the AKA stump,
4.Negative pressure dressing to left groin 10 cm length x 2cm width x 1 cm depth
Pre-Operative Diagnosis: infected AKA stump and infected SFA covered stents
Post-Operative Diagnosis: same
Estimated Blood Loss: 75 cc Specimens Removed: SFA and stent for culture, cultures sent Findings: infected SFA just distal to origin with exposed stent just distal to the origin
Operative Report: The patient was taken to the OR for a necrotic wound and was undergoing debridement of his AKA stump noting necrotic muscle and tissue which as debrided by Dr. and he noted purulent drainage from the SFA and I was called into the OR. We extended the medial incision along the sarotorius and mobilized the SFA off the FV. We controlled any bleeding of the FV with a 6-O prolene suture. As we mobilized proximally we noted purulent drainage from the more proximal SFA and noted there was exposed stent. We sent cultures and at this point we opted to take the SFA at the origin to ensure we removed all infected tissue as well as all the covered stents. We then made an longitudinal incision overtop the artery and used electrocuatery to dissect down to the femoral sheath. The inguinal ligament was identified as well as the CFA which was noted to have a posterior plaque. We ascertained circumferential control of the CFA with a vessel loop. We dissected out the SFA and PFA and ascertained circumferential control. We controlled any bleeding with suture ligation and hemoclips. We then heparinized the patient and waited three minutes to allow circulation time. We clamped proximally, the profunda and SFA as well as any branches that we controlled with vessel loops. We then transected the SFA from the origin.
