Operative Report:
1. Exact name of Operative Procedure:

Only the operative report should go in this section in the left column.

Photos

Tourniquet: finger / forearm / arm
Drain: Type of drain and placement
Sutures: List all layers
Dressing: What's preferred?

Anatomy: Pertinent anatomy should be listed

Post-operative care: Include restrictions, splints, etc…

Attending Pearls (Learning points/Pimp Questions):

Operative Report:
1. Irrigation of left lower extremity wound
2. Excisional debridement of skin and subcutaneous tissue of left lower extremity wound using scissors/adson forceps and bovie electrocautery 15x15cm + 20x4cm total area of debridement.
3. Application of Acell micromatrix powder and 3-layer wound matrix covering wound 1225 cm squared.
4. Application of negative pressure wound therapy, 1225 cm squared.

INDICATIONS FOR PROCEDURE: The patient is a 24 year old woman with traumatic left lower extremity Morel-Lavallee lesion that has undergone prior washouts and debridements with the trauma surgery team. Plastic Surgery was consulted to assist in closure given the extent of the wound. Based on the size, we recommended application of Acell. The details of the procedure including risks and benefits were discussed with the patient. She voiced understanding and agreed with the plan. Written and verbal consent was obtained.

DESCRIPTION OF PROCEDURE: The patient was transported to Operating Room #4 and placed supine on the table with pressure points appropriately padded. A pre-anesthesia time-out was performed. The patient was administered general anesthesia without complication. Pre-operative antibiotic prophylaxis was administered. The left leg was elevated using a candy cane. The wound vac was removed in its entirety. The surgical field was prepped and draped in the usual sterile fashion. A final time-out was performed.

The wound was sharply debrided of necrotic subcutaneous tissue including fat at the anterior medial aspect of the distal thigh and skin/subcutaneous tissue at the anterior lateral aspect of the proximal lower leg. The areas of excisional debridement were 15x15cm and 20x4cm, respectively. Adson forceps/scissors as well as bovie electrocautery were used for the excisional debridement. The remainder of the wound was mechanically debrided with a laparotomy pad and with the back end of the forceps. The wound was thoroughly irrigated with 3L and adequate hemostasis was obtained. Three 15 French round fluted Blake drains were placed under the skin flaps– two at the superior aspect, medially and laterally, and one at the inferior aspect. The drains were sutured in place with 2-0 Nylon and attached to drainage bulbs. There was undermining at the lateral aspect of the wound superiorly and inferiorly. The skin flaps were tacked down to the wound bed with 3-0 Vicryl sutures. The wound in its entirety now measured 1225 sq cm.

At this time, Acell micromatrix powder was mixed with normal saline into a paste. The paste was applied to the entire wound bed, ensuring application into the undermined areas as well. The Acell wound matrix sheets were laid over the paste and stapled in place. Adaptic was then laid over the Acell sheets and also stapled in place. Black sponge negative pressure wound therapy was applied to the wound with two “lily pad” suction sites attached with a Y-connector to the vac device. Adequate seal was noted on 125 mmHg suction. The drain sites were dressed with BioPatches and Tegederm.

Photos

Tourniquet: Not used
Drain: 3x 15 French round fluted Blake drains
Sutures: Drain stitches: 2-0 nylons
Dressing: Adaptic over acell stapeled in place, wound vacuum

Anatomy: Pertinent anatomy should be listed

Post-operative care:
-Less you mess with wound dressing the better- change secondary dressing when excessively soiled/dirty.
-Leave non-adherent dressing (adaptic/Xeroform/MepitelOne) sutured/stapled on top of defect until product is resorbed.

Learning points/Pimp Questions: