If someone could help me with this op report it will be so so appreciated.
POSTOPERATIVE DIAGNOSIS: Left posterior scar dehiscence.
PROCEDURE: Left ankle posterior incision revision and I&D.
DESCRIPTION OF PROCEDURE: Catherine Sypher is a 50-year-old female status post left ankle Achilles tendon repair. At the last postoperative visit, she was found to have an area of the dehiscence and granulation along the mid portion of the incision. I recommended a scar revision and I&D. The patient had no constitutional symptoms, fevers, chills or surrounding erythema or significant drainage; however, the incision had dehisced slightly. I explained to the patient the risks and benefits of procedure, risks not limited to, but including infection, DVT, damage to surrounding structures, need for more procedures. The patient was accepting of these risks and wished to proceed with surgical management and was able sign surgical consent.
On the day of surgery, the patient was met in the preoperative holding area and appropriate site and side were signed. The patient received 2 g Kefzol prior to any incisions and was taken back to the operating suite where she was placed supine on the operating room table, was placed under general anesthesia and was intubated. She was then placed in supine position and a well-padded tourniquet was placed on the left thigh. Left leg was then prepped and draped in usual sterile fashion and surgical timeout was conducted with attending surgeon present and we proceeded with standard posterior portion of the left ankle. Previous scar incision was inspected and the leg was elevated an exsanguinated and the tourniquet was inflated to 250 for the duration of the case which was 50 minutes. The incision was just off midline to the medial side posteriorly and was well-healed except for 1 central area, which had some dehiscence as well as a simple suture material, which was visible in this granulation tissue. An incision was
made along the previous incision line and subcutaneous tissues were then divided and soft tissue flaps were elevated, both medially and laterally exposing the underlying tendon repair and the tendon material on the medial side, there was a "ball of the suture material, which had become quite prominent and this was simply removed with a rongeur and was basically afree group of suture. Some of the tendinous material also looked necrotic and looked essentially avascular and this was simply removed sharply with Metzenbaums and a knife. This was medially based; however, I probed
laterally and found that the repair was intact and essentially normal Thompson's test intraoperatively was negative. There was no gross purulence or drainage or erythema around the area. The incision edges were then ellipsed out from this granulation type tissue and the wound was copiously irrigated after 2 swabs were taken and sent for microbiology.
The incision was then closed with a layered closure using 2-0 PDS interrupted inverted for subcutaneous and deep dermal layers and vertical mattress of 3-0 nylon was used to reapproximate skin. The skin edges were easily reapproximated under no tension. Tourniquet was let down. There was no blanching of the skin. The incision was then dressed with Xeroform dry or dressing and sterile Webril and a posterior splint was applied to the left lower extremity in 10 to 20 degrees of plantar flexion. The patient was then flipped to the supine position, was awoken from anesthesia, extubated and transferred to the stretcher and PACU in stable condition. All counts were correct. I was the attending of record was present for the entire procedure. The patient will be nonweightbearing on left lower extremity and will be on Keflex for antibiotic wound prophylaxi for 10 days, will be given appropriate analgesia and antiemetics for home
use and will be on aspirin for DVT prophylaxis. I was the attending of record was present for the entire procedure. All counts were correct.
Thank you so much!!!
Wound dehiscence
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