CPT 49002
CPT 13160.51
or
CPT 49900
Indications: Presents with large volume of leakage from incision and wound opening, concern for fascial dehiscence. He was brought urgently to the OR for wound exploration and reopning of ex lap.Pt signed consent, understanding the risks and benefits.
Diagnosis: Fascial dehiscence
Procedure:
Wound exploration
Reopening of Ex lap
Complex fascial closure
Findings: Immediately on removing staples it was noted that fascia had completely dehisced, bowel appeared healthy, G tube well secured but tissue as weak throughout. Fascia noted to be weak.
Detail: The patient was brought to the operating room with informed consent and general anesthesia was induced. The position was supine. Sterile preparation and draping of the abdomen was performed. Preoperative antibiotics were administered. Time out was performed confirming the patient and procedure. We removed the staples prior to prepping the abdomen and noted complete dehiscence of fascia with exposed bowel. After abdomen had been prepped and draped we removed the prolene fascial sutures and irrigated the abdomen and noted bowel to viable without any injuries. The previous abdominal closure at outside hospital had torn away from fascia and bowstringed in the midpoint applying pressure to underlying bowel. This was very carefully inspected and no injury to underlying bowel was identified. The gastrostomy tube was confirmed to still be in good position. It was noted that the patient has significant weakness of fascia and tissue. Flaps were raised of the skin and sucutaneous tissue to access the fascia because the fascia was too weak to close with a conventional running non-absorbable stitch. A running 2-0 Vicryl was used to close the peritoneum. The fascia was then closed with interrupted 0 PDS. The entire closure was then re-inforced with stratafix suture running imbrication stitch. The skin was loosely closed with staples and packed with tefla in between. Patient tolerated the procedure well without any immediate complications. He was extubated and taken to PACU