Eva Posted Fri 05th of July, 2013 21:18:58 PM
Can anyone point me in the right direction with this op report; I am completely stumped...
Overlying the below-knee popliteal incision, initially a limited
incision was made for about 3 cm with a scalpel blade and it was
extended superiorly for about 1 cm. This was carried down with
electrocautery down to the subcutaneous tissue. There was a
significant amount of scarring that was encountered, which made
dissection rather difficult. Meticulous dissection occurred for
the better part of two hours until we identified the bypass
graft. The incision had to be extended distally so we could
dissect down to the scar tissue to identify the gastrocnemius
muscle. This was then brought down. Again, after meticulous
dissection for the better part of two hours, the bypass graft
was identified. The anastomosis was inspected. It appeared to
be patent, but when we followed the bypass up through the
tunnel, it was evident that under the fascia there was some
kinking of the bypass as it appeared to be flattened. A Doppler
was brought to the field. There was a triphasic signal in the
bypass with the leg bent. When we straightened the leg, the
triphasic state of the signal went away and there was only a
biphasic signal. This fascia was then incised for a level of
about 5 cm up to the level of the mid-knee and beyond. Once we
did this, there appeared to be a much better lie of the bypass.
There was not a significant amount of extrinsic compression on
the bypass as there was before. We also decided to perform a
limited right lower extremity angiogram.
A 19-gauge butterfly was then inserted into the bypass graft.
Initially with the leg bent, a limited angiogram was performed.
The anastomosis appeared to be patent. There appeared to be no
evidence of any significant kinking or stenosis of the bypass as
it coursed through the tunnel. Runoff was essentially two-
vessel runoff that was unchanged from previous imaging. Next,
we then did straighten the leg and reperformed an angiogram,
which confirmed that there was no significant stenosis of the
bypass graft along its newly released tunnel. The anastomosis
was patent and the patient had two-vessel runoff. At this
point, we were satisfied with the degree of releasing of the
bypass. The butterfly needle was removed. Pressure was held
with Surgicel. Hemostasis occurred of the bed wound.
SuperCoder Answered Sun 07th of July, 2013 21:42:34 PM
We have a separate tool named Supercoding-on-Demand to get the complete OP report coded. Please contact customer service Manney at 866-228-9252 Extn : 4165