Patient with necrotizing soft tissue infection of the abdominal wall, secondary to necrotizing soft tissue infection of the subcutaneous fat with panniculitis.
Procedure: extensive debridement of abdominal wall pannus.
Patient was taken emergently to the operating room, placed in supine position. General endotracheal anesthesia was induced. A transverse incision was made above the umbilicus to incorporate the previous I&D site. Dissection was carried through the subcutaneous tissues down to the level of the fascia. The fascia was inspected and noted to be intace and viable without evidence of fasciitis. The overlying skin was also viable. However, there was extensive edema and necrosis of the subcutaneous fat. This was aggressively debrided using sharp dissection. There had been extensive spread of the panniculitis, requiring extensive debridement. The incision was extended in both directions and debridement was carried out to the posterior axillary line on both sides of the abdomen. In additon debridement was carried up nearly to the costal margin and down to just above the pubis. Large amount of necrotic fat were debrided. Aerobic and anaerobic cultures were obtained both of the fluid of the wound as well as tissue cultures. After extensive debridement had been undertaken, the wound was copiously irrigated with sterile saline carefully inspected to ensure adequate hemostasis. The wound was then packed with Kerlix rolls soaked in bacitracin solution.
I am thinking 11005 but debridement was not done to the fascia or muscle. Also for ICD-9 can I use 686.9? Can you help?
