DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Abdominal wall abscess and wound infection.
POSTOPERATIVE DIAGNOSES:
1. Abdominal wall abscess and wound infection.
2. Necrotic tissue in abscess wall.
3. Loose suture in mesh.
OPERATION PERFORMED:
1. Incision and drainage of abdominal wall abscess.
2. Debridement of abdominal wall necrotic tissue, both subcutaneous and fascia.
3. Revision of mesh with placement of new suture.
SURGEON: John Doe, MD
ASSISTANT: None.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: After proper consent was obtained, the patient was brought to the operating room and placed on the table in the supine position. General anesthesia was administered by the anesthetist. The patient tolerated this well. The abdomen was prepped and draped in a sterile manner. The visible Vicryl sutures at the area of the open wound superiorly were cut with scissors and removed. Finger fracture technique was used to open up the rest of the subcutaneous space and skin down to the bottom of the wound, and there was a large abscess cavity.
Fibrinopurulent debris and purulence that were in the abscess cavity were submitted for culture analysis. Necrotic skin, subcutaneous tissue, and some necrotic fascia near the edge of the mesh placement were excised sharply with scissors back to areas of healthy-bleeding tissue. Significant amount of the abscess wall had some superficial necrotic subcutaneous tissue requiring debridement sharply. Care was taken to provide the hemostasis with cautery in meticulous fashion at bleeding points.
There were two areas where the Prolene suture holding the AlloDerm mesh in place was noted to be loose, and this was pulled out at a loop on a hemostat and tied by placing 0 Prolene suture adjacent to that site and tying knot down and then tying the loop of suture to that suture. This was done on both sides to shore up the suture such that the running suture holding the mesh in place was taut. The mesh was intact. No evidence of any recurrence of hernia. The mesh prosthesis of AlloDerm does not appear to harbor any necrotic tissue or infection.
After pulse lavage irrigation with 3 liters of saline solution, the abscess cavity was inspected and rendered hemostatic with cautery at bleeding points and then packed with three Kerlix rolls moistened with Betadine. This was covered with Betadine and firm tape dressing was placed. The patient had her anesthesia reversed and was taken to the recovery room postoperatively.
