DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Diabetes.
2. Left upper extremity soft tissue infection.
POSTOPERATIVE DIAGNOSES:
1. Diabetes.
2. Left upper extremity soft tissue infection. Infection appeared to be contained to subcutaneous tissue and there was no evidence of necrotizing soft tissue infection including myonecrosis.
OPERATION PERFORMED:
Incision and drainage of left upper extremity soft tissue abscess.
SURGEON: John Doe, MD
ANESTHESIA: General LMA.
DESCRIPTION OF PROCEDURE: The patient was prepped and draped. We identified the old incision; this was elongated. Loculations of fibrous tissue were broken up. An inflammatory rind was identified and this was sent for culture. Seropurulent, somewhat bloody fluid was noted. The infection appeared contained to a golf ball-sized area in the subcutaneous tissues above the fascia. There was no evidence of myonecrosis, penetration of the fascia or significant extent along the fascia of the infection. We cleaned the area with Betadine and then packed the wound with Betadine-soaked Kling. Dry dressings were applied. The patient appeared to tolerate the procedure well.
Incision and Drainage Sample #2
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Back abscess.
POSTOPERATIVE DIAGNOSIS:
Back abscess.
OPERATION PERFORMED:
Incision and drainage of back abscess.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: After appropriate consent was obtained, the patient was brought to the operating room and placed on the table in supine position. General anesthesia was administered. Due to the patient’s obesity, a second table was brought to the room. The patient was then rolled up on 2 beanbag devices using both beds to support her body. Care was taken to properly position and pad this patient in the left lateral decubitus position. The area of the back abscess was prepped and draped in sterile manner. An incision was made with a #15 blade transversally across the area of the palpable fluctuance and where there was noted to be drainage through the skin. Thick malodorous purulence was encountered and this was completely drained. This was sent for culture analysis as well. Loculations were broken up inside the abscess cavity with digital inspection, and there was no evidence of any significant tracking of purulence up or down any muscle or fascial planes. Copious irrigation was then used to clean the abscess cavity. Cautery was used as needed to provide for hemostasis. The wound was then packed with 2 inch gauze packing and then covered with sterile dry gauze dressing. The patient was turned to the supine position where she was extubated, placed back on a stretcher and taken to the recovery room.
Incision and Drainage Sample #3
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left facial abscess.
POSTOPERATIVE DIAGNOSIS:
Left facial abscess.
PROCEDURE PERFORMED:
Incision and drainage of left facial abscess.
SURGEON: John Doe, MD
DESCRIPTION OF PROCEDURE: The patient was brought to the ambulatory care in supine position and was prepped and draped in sterile fashion. Xylocaine 1% with epinephrine was injected in the area. The punctum site was then excised in an elliptical fashion. Dissection was carried to the pocket. Purulent material was expressed and this was cultured. The wound was irrigated with bacitracin irrigation. It was subsequently packed with half-inch plain gauze soaked in bacitracin. The patient tolerated the procedure well and was subsequently returned to the hospital floor.
Incision and Drainage Sample #4
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Glabellar abscess.
POSTOPERATIVE DIAGNOSIS:
Glabellar abscess.
PROCEDURE PERFORMED:
Incision and drainage of glabellar abscess.
SURGEON: John Doe, MD
ANESTHESIA: General.
PROCEDURE FINDINGS: A 2.5 x 2.5 cm glabellar abscess filled with pus and sebum. No extension to the sinuses.
DESCRIPTION OF OPERATION: After informed consent was obtained, the patient was brought to the operating room suite and placed in the supine position. After induction of general anesthesia via LMA, the patient was turned 90 degrees to the right. Nasal dorsum and glabellar area were injected with 1% lidocaine with 1:100,000 epinephrine. A transverse incision was made at the junction between the glabella and the nasal dorsum. Purulent fluid and sebum were encountered. A culture was taken. The abscess was evacuated and then irrigated copiously with saline. Iodoform gauze was then packed into the wound. The patient was then turned over to anesthesia and was awakened without complication. Estimated blood loss was less than 10 mL.
Incision and Drainage Sample #5
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Left hip hematoma after hip revision.
POSTOPERATIVE DIAGNOSIS:
Left hip hematoma after hip revision.
PROCEDURE PERFORMED:
1. Left hip incision and drainage.
2. Hematoma evacuation and closure over drain.
SURGEON: John Doe, MD
SEDATION: General.
COMPLICATIONS: None apparent.
DESCRIPTION OF PROCEDURE: After establishment of general anesthetic, IV antibiotics were given. The patient was placed in the lateral decubitus fashion using a beanbag. The left lower extremity was prepped and draped in the normal sterile fashion. Following this, all staples were removed. The obvious hematoma involving the left hip at the site of hip revision was opened with the previous incision. The superficial fascia had a large hematoma. Multiple large fragments of clot were removed. There was no obvious pus. The fascia was intact. After evacuation of the hematoma and irrigation with pulsatile lavage, bacitracin solution was used followed by gentle debridement back to excellent fresh tissue with excellent color and bleeding response. There was no necrosis, no obvious pus. Once the hematoma was evacuated, the overlying skin flaps already improved from a vascular standpoint with decreased ecchymosis and improved skin turgor. Therefore, palpation of the fascia was performed. There was mild tension. Therefore, the fascia was opened and then minimal hematoma was evacuated from the deep area. There was no significant deep hematoma. The prosthesis appeared well. Cultures were taken in both the superficial and the deep fascia and sent for anaerobic-aerobic fungal culture. Following this, further irrigation with bacitracin was performed. At least 5 liters was performed in total and it should be noted that multiple times throughout the case suction tips, outer drapes and gloves were changed to improve the environment. Instruments were cleaned and multiple irrigations and debridement were performed sequentially. The wound was thoroughly irrigated. The fascia was closed overlying a drain. The superficial fascia was reapproximated with minimal sutures and then large nylon sutures were used to reapproximate the superficial fascia and dermis and epidermis to close down the potential space. Following this, a bulky dressing was applied, multiple ABDs and a compression hip spica dressing was placed followed by the patient’s standard brace to decrease the risk of instability. The patient tolerated the procedure well. There were no apparent complications.
Incision and Drainage Sample #6
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Right leg abscess.
POSTOPERATIVE DIAGNOSIS:
Right leg abscess.
PROCEDURE PERFORMED:
Incision and drainage of right leg abscess.
SURGEON: John Doe, MD
ANESTHESIA: General.
ESTIMATED BLOOD LOSS: Less than 20 mL.
DESCRIPTION OF PROCEDURE: The patient was brought into the operating room and placed on the operating table in the supine position. General anesthesia was administered. He was then prepped and draped in the usual sterile fashion. Skin was incised sharply with a scalpel over the fluctuant mass in the anteromedial right leg. Copious amount of purulence was drained; this was suctioned. The wound was probed. The fibrous bands were broken up. The skin incision was extended both superiorly as well as inferiorly. Hemostasis was achieved with electrocautery. The wound was then packed with Betadine-soaked gauze. A dry dressing was placed around this followed by an Ace wrap. The patient tolerated the procedure well. He was extubated and transported to the recovery area in stable condition.
Incision and Drainage Sample #7
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Recurrent infected pilonidal cyst.
POSTOPERATIVE DIAGNOSIS: Recurrent infected pilonidal cyst.
OPERATION: Incision and drainage of recurrent infected pilonidal cyst.
SURGEON: John Doe, MD
ANESTHESIA: Lidocaine 1% with epinephrine local infiltration.
DESCRIPTION OF PROCEDURE: The patient was placed in a prone position. The sacrococcygeal area was prepped with Betadine and draped in the usual manner. There was a tender, fluctuant swelling just deep to a healed surgical scar, which was located to the left of the midline in the sacrococcygeal area. This area was infiltrated with 1% lidocaine with epinephrine. A cruciate incision was made through the previous scar. It was deepened to subcutaneous tissues. The incision was carried down into the abscess cavity. This was drained. There was mostly edema fluid tinged with blood. There was little purulent fluid present. The entire cavity was laid open. It was irrigated with saline. A half inch Penrose drain was then placed within it and sutured with a 3-0 silk suture. A bulky dry sterile dressing was applied. Blood loss was minimal. The patient tolerated the procedure well.
Incision and Drainage Sample #8
DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Postoperative infection.
POSTOPERATIVE DIAGNOSIS: Postoperative infection.
PROCEDURE PERFORMED: Incision and drainage of complex postoperative wound infection.
SURGEON: John Doe, MD
ANESTHESIA: General via endotracheal tube.
ESTIMATED BLOOD LOSS: Less than 200 mL.
COMPLICATIONS: None.
DESCRIPTION OF PROCEDURE: The patient was taken to the operating room. General anesthesia was induced via endotracheal tube. The patient was receiving IV vancomycin preoperatively. The right lower extremity was prepped and draped in a sterile fashion. The surgical sutures were removed. The wound was opened. Gross purulent material was encountered. Cultures were obtained. Debridement was performed. All necrotic tissue was debrided and the wound was copiously irrigated with 9 liters of pulsatile normal saline, 3 liters of which contained 50,000 units of bacitracin solution. Excisional biopsy cultures were sent for microbiology. The wound was then closed with 0 PDS suture at the fascial level and 2-0 nylon running suture at the skin level. Sterile compressive dressings were applied. The patient was taken to the PACU in stable condition. There were no complications. The reconstructive plan for this patient will include return trips to the operating room in 24 to 96 hour intervals for repeat incision and drainage, possible gastrocnemius rotation flap, possible removal of hardware stabilization and spanning external fixator depending on the status of the wound.
Incision and Drainage Sample #9
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Right thigh hematoma.
POSTOPERATIVE DIAGNOSIS: Right thigh hematoma.
PROCEDURE: Incision and drainage of spontaneous subcutaneous right thigh hematoma.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. After adequate induction of anesthesia, the right thigh was prepped and draped in a sterile fashion. A longitudinal incision was then made in the mid thigh medially, which entered the subcutaneous cavity. The blood was under extreme pressure and was not coagulated and very runny. All the blood was evacuated. The incision was extended for a total distance of 30 cm along the thigh. The 2 flaps had suffered full-thickness necrosis and were debrided back to facilitate packing. A pulse evacuator was used to irrigate out the wound to remove hematoma. No specific bleeding site was identified. There were no venous or arterial major vessels identified in the wound. There was no communication with the retroperitoneum. The entire wound appeared to be subcutaneous. After the wound had been irrigated and hemostasis ensured, the wound was packed with saline-soaked Kerlix packs. A clean, sterile, dry compression dressing was placed and the patient was transferred directly to the ICU.
Incision and Drainage Sample #10
DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Intramuscular abscess of the right forearm with superimposed cellulitis.
POSTOPERATIVE DIAGNOSIS:
Intramuscular abscess of the right forearm with superimposed cellulitis.
OPERATION PERFORMED:
Incision and drainage of intramuscular abscess of the right forearm.
SURGEON: John Doe, MD
ANESTHESIA: General.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed in the supine position. After adequate general anesthesia was obtained, the patient’s right upper extremity was prepped and draped in the usual fashion. An incision was made over the brachioradialis muscle group. Sharp dissection was done to the deep fascia. There was no purulence within the subcutaneous tissue; however, the fascia of the brachioradialis was quite tense, and once it was incised, gross purulence came from the muscle itself. Blunt dissection was done within the muscle and a cavity was identified. The purulence was in this cavity and went from the elbow down to the junction of the middle and distal third of the forearm. The cavity was evacuated of purulence and cultures were obtained. Copious amount of irrigation of the cavity was performed. After copious irrigation was completed, the wound was dressed open with antibiotic-soaked sponges. The patient’s wound was dressed after that with dry dressings. The patient was awakened and brought to the recovery room in good condition.
