The patient had had an aggressive left breast cancer that required mastectomy and then later had a recurrence that required radiation therapy which progressed. She ultimately had to have a chest wall resection and to cover this an implant and a latissimus flap were used. This was in 2017. She has had a sinus tract for the past two to three weeks.
The medial portion and inferior portion of the latissimus flap were opened with the use of a #10 knife blade. Bleeding was controlled with electrocautery. At this point, copious amounts of purulent drainage were identified and this was cultured. The myocutaneous flap, this was a latissimus myocutaneous flap that had been fashioned by Dr. B several months ago, was actually fairly adherent to the Proceed mesh. Underneath this, there was an opening that had to be bridged with a prosthesis/implant several months ago. She had had a chest wall resection where we removed several ribs. The entire chest wall and lung were present and could be visualized. The prosthesis/implant was fashioned with methyl methacrylate and Proceed mesh as a sandwich type prosthesis. It was fashioned appropriately and originally affixed to the chest wall and ribs with wire.
The incision this time required dissecting the myocutaneous flap off of the mesh and the methyl methacrylate implant. This was peeled back and drainage was identified as well as granulation tissue. All wire sutures were removed, and in doing so we removed the entire implant, as I stated consistent with a sandwich of Proceed mesh and methyl methacrylate. At this point, using a curette and a rongeur, all granulation tissue and obviously infected tissue was debrided. We did not have to place a new implant because the pleura underneath the prosthesis had sealed, there was no evidence of a pneumothorax, and there was no exposure of the lung.
At this point, the task was to remove all infected tissue as well as all foreign bodies that had been impregnated in the surrounding tissue. This also required debridement of granulation tissue from underneath the flap. The flap remained quite viable. Again, after removing this we irrigated the defect with 3 liters of saline to which bacitracin was added.
I cannot find a code that addresses this adequately. Help please????