Question

Gary I. Sanchez, M.D.

PREOPERATIVE DIAGNOSIS: Necrotizing wound infection, one week status post Cesarean section.

POSTOPERATIVE DIAGNOSIS: Same.

PROCEDURE PERFORMED: Wide wound exploration; excision of necrotic skin and subcutaneous tissue; debridement of abscesses. Frozen section obtained intraoperatively revealed a mixed picture of granulation tissue, inflammation, and necrotic tissue. The necrosis did not extend to the edge of resection. The edge of resection was viable.

PROCEDURE: After good general endotracheal anesthesia, the patient was prepped and draped in the usual sterile fashion. The entire previous C-section incision was opened from side-to-side, and the necrotic skin edges were trimmed away. Specifically, there was a 6 by 6 cm central portion of grossly necrotic tissue that was debrided away. The subcutaneous tissue beneath this was clearly necrotic, and this was also debrided away. Skin edges on both sides were debrided away until there was bleeding, viable tissue noted. The incision was extended laterally as there was infection that had tracked laterally on both sides, and abscess cavities were uncovered here. All clearly necrotic tissue was debrided away. Hemostasis was obtained with electrocautery. The wound was irrigated and then packed with some damp Kerlix. Plans were made to look at the wound again tomorrow in the operating room and debride away any other marginal tissue.
Pathology Report Later Indicated: Granulation tissue, inflammation, and necrotic tissue.

Needed ICD 10, CPT, HCPCS

Answer 1

Procedure-Wide wound exploration; excision of necrotic skin and subcutaneous tissue- CPT 11004

Dx- Abdominal wound infection - ICD S31.609S

Dx -S/P C section infection - O86.0- ICD