11044 and closure 13121 13122 or 12044?

PREOPERATIVE DIAGNOSIS:

Infected left olecranon bursa with Nocardia.

POSTOPERATIVE DIAGNOSIS:

Infected left olecranon bursa with Nocardia.

PROCEDURE:

Irrigation and debridement of left elbow wound (8.0 cm) and wound

Closure.

SURGEON:

ANESTHESIA:

General LMA.

ESTIMATED BLOOD LOSS:

Minimal.

COMPLICATIONS:

None.

BRIEF CLINICAL HISTORY:

This is a 41-year-old right-hand dominant white male with

history of injury to his left elbow while riding a mountain

bike several weeks ago. He has had swelling of the elbow and

has had repeat aspiration. He was noted on repeat aspiration

to have possible infection. Initial cultures have grown up

Nocardia but sensitivities are pending. He had some

improvement, but had recurrence of the swelling and infection.

Options of continued conservative care versus surgery were

discussed with him at length. He requested surgical

treatment. About 3 days ago he underwent excision of the

infected bursa and debridement of the wound. Because of

infection, the wound was packed open. He was kept on

antibiotics. With the Nocardia, Infectious Disease was

contacted previously and they recommended Septra and he was

kept on this. He is now for repeat irrigation and debridement

and possible closure.

DESCRIPTION OF PROCEDURE:

After obtaining informed consent, the patient was brought to the

operating room and placed on the operating room table in supine position. After administration

of general LMA anesthesia, the tourniquet placed on the left

upper arm, a time-out was performed. The patient was identified,

appropriate body site was marked, and he received appropriate

antibiotics. Next, the dressing was removed and the left arm

was sterilely prepped and draped in a routine manner with

Betadine. The wound, about 8.0 cm in length was explored and appeared clean with good

granulation tissue. No abscess or infection was noted. The

area was debrided and then copiously irrigated with pulse lavage irrigation

with 2 bags of bacitracin also. Adequate hemostasis was noted

in the wound. Next, interrupted Vicryl sutures used to

approximate the deep tissue and fascia and nylon sutures were

used to approximate the skin edge. The area was debrided down

to the olecranon and triceps tendon. Good debridement was

noted prior to closure. Good closure was noted. A sterile

dressing was applied. The patient was placed in a padded posterior splint

and transferred to recovery in stable condition.

I stressed with he and his mother the importance of limiting

use of the arm. He works as an auto repair mechanic and has

been trying to work with. I told him to decrease the

likelihood of recurrence of infection, he needs to be very careful

with limited use of the arm and avoid flexion and extension of

the elbow for at least the next 1-2 weeks. He is going to

continue his Septra. He has some occasional tramadol and

Valium to help with his pain. He gets claustrophobic with the

dressing. He is to follow up on Tuesday for recheck and we

will try and get him some kind of brace with a hard padded elbow

support. Return sooner for any problems. He is aware of the

risk of recurrence evidence of infection. He has been poorly

compliant with recommendations for limited use of the arm. He

actually showed me how he is bending the elbow up and down

even in dressing and splint, prior to surgery.

11044 and closure 13121 13122 or 12044?