DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Right upper extremity above-elbow amputation wound.
2. Right flank wound.
POSTOPERATIVE DIAGNOSES:
1. Right upper extremity above-elbow amputation wound.
2. Right flank wound.
PROCEDURES PERFORMED: Irrigation and debridement of right upper extremity above-elbow amputation wound and right flank wound with split-thickness skin grafting to right upper extremity amputation site and right flank wound.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: 100 mL.
DRAINS: None.
SPECIMENS: None.
TUBES: VAC dressings placed over both right arm stump and right flank skin graft.
COMPLICATIONS: None.
CONDITION OF PATIENT: Stable to recovery.
INDICATION FOR PROCEDURE: The patient is an adult male who was involved in a significant trauma several weeks ago. The patient had a traumatic injury to his right arm, which resulted in a right above-elbow amputation that was left open. The patient had VAC dressing changes in order to allow the soft tissues to heal surrounding the stump as well as to allow granulation. The patient also had a large right flank wound, which was debrided and had a VAC dressing placed as well. The patient has been receiving VAC dressing changes every two to three days in the burn unit, and recently, his wounds were examined and felt able to skin graft. The patient has been consented appropriately for this procedure and understands the risks and benefits of this procedure, including the fact that it is possible that the graft could not take. The patient has been consented appropriately.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating room table. General anesthesia was initiated, and the patient was then turned into the left lateral decubitus position and held in this position using a beanbag. All neurovascular structures and pressure points were padded appropriately. The pre-existing VAC dressings were removed, and the right upper extremity stump as well as the right lower extremity and right flank were prepped and draped in a sterile fashion. Three liters of normal saline were used to irrigate the upper extremity stump under Pulsavac lavage and then scissor and scalpel dissection were used to remove any compromised tissue. Overall, the tissue appeared very healthy.
After this, 6 liters of normal saline was used to irrigate the right flank wound, and curettes and scalpel were used to debride the wound to a healthy bleeding base. There was some serous fluid that had collected in the distal aspect of the wound, where a degloving injury to the patient had occurred. There was no evidence of infection. There was only serous fluid. At this point, a curette was placed into the area that had been degloved between the muscle and more superficial plane, and this area was curetted and debrided appropriately.
At this point, the decision was made to proceed with split-thickness skin grafting of each wound. Each of the wounds was measured, and the right upper extremity wound was found to measure 12.5 cm 12.5 cm in size. The right flank wound was measured and was found to measure approximately 32.5 cm x 15.5 cm in size. An appropriately sized skin graft was then harvested in a split-thickness fashion from the patient’s right lateral thigh. The skin graft was meshed in a 2:1 manner and then applied to the right upper extremity and the right flank in a standard fashion. The skin graft was secured with staples and chromic suture.
After this, Adaptic was placed over each of the skin graft sites and VAC dressing was placed back on the right upper extremity stump and the right flank with Adaptic separating the VAC sponge from the skin graft. Xeroform was placed over the skin graft donor site and a standard sterile dressing was placed. The VAC dressings were hooked up to suction and found to have a normal seal. At this point, all dressings were removed and the patient was awoken from general anesthesia and transported to recovery in stable condition.
