HELP, placement of biologic mesh

patient had undergone incisional hernia repair and mesh became infected and was subsequently removed. Two days later patient taken back for washout and replacing mesh. Need help coding this note:

PREOPERATIVE DIAGNOSIS: Infected ventral hernia mesh.

POSTOPERATIVE DIAGNOSIS: Same.

PROCEDURE: Abdominal wound washout, placement of Strattice biologic mesh (20 x 30 cm mesh trimmed at 19 X 27 cm), and wound VAC placement.

ANESTHESIA: General.

SPECIMENS: None.

FINDINGS: The posterior sheath remained intact. The posterior rectus space appears healthy. No purulence and no fluid collections. All the tissue appears viable and healthy.

ESTIMATED BLOOD LOSS: Less than 100 mL.

IMPLANTS: Strattice mesh (20 x 30 cm mesh trimmed to 19 x 27 cm).

INDICATIONS FOR THE PROCEDURE: The patient is a 71-year-old female who had undergone a Stoppa incisional hernia repair. The posterior rectus sheath had developed a defect and the mesh was exposed to the small bowel. This resulted in a small bowel obstruction and then subsequent erosion and perforation of the small bowel into the retrorectus space. The infection was confined to this location. She had undergone lysis of adhesions with small bowel resection and then abdominal washout. The posterior rectus sheath at the left lateral aspect where the defect was prepared primarily. The wound was copiously irrigated at that time and a wound VAC was placed in the posterior rectus space. She had undergone IV antibiotic therapy. Plan is made for return to the OR for wound evaluation and if appropriate placement of biologic mesh. The risks and benefits, and alternatives of procedure were discussed with the patient and her family and they wished to proceed.

DESCRIPTION OF THE PROCEDURE: The patient was taken to the operating room theater. She was placed in supine position. General anesthesia was induced. She was receiving systemic antibiotic therapy. The patient's wound VAC was taken down and the abdomen was prepped in the normal sterile fashion and draped. The sponge from the wound VAC was removed. The lower sponge and the posterior rectus sheath was also carefully removed. The posterior rectus sheath was found to be intact. The posterior rectus space was all found to be healthy in appearance. There was no purulent fluid. There are no fluid collections. This all had a healthy wound base. 1000 mL of irrigation was then irrigated to the space with a Pulsavac irrigator. The defect was then measured. This measured 19 cm in the craniocaudal direction by 27 cm transversely. A 20 x 30 cm Strattice biologic mesh was then chosen. This was then trimmed to this size. This was then placed in a retrorectus position from her prior component separation. This was then tagged at the lateral aspect with 0 Vicryl sutures. Using a suture passer device, these were then passed transcutaneously. This was done circumferentially around the margins of the mesh. This then laid in excellent fashion. These were then tied down. A 15 round drains were then placed to each lateral recess site. These were secured with 3-0 nylon. The anterior rectus sheath was then closed over the mesh, taking intermittent small bites of the mesh to fix this in the midline. This was done with a PDS plus antibiotic suture and tied in the middle. Prior to closing this, hemostasis was evaluated and was found to be excellent. A wound VAC was then placed to the subcutaneous tissues. This held an excellent seal.

The patient tolerated the procedure well. There were no complications. All counts were correct as reported to me at the end of the case.

HELP, placement of biologic mesh