DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Chronic subcutaneous abscess of a midline wound.
2. Large left thigh lipoma.
POSTOPERATIVE DIAGNOSES:
1. Chronic subcutaneous abscess of a midline wound.
2. Large left thigh lipoma.
OPERATION PERFORMED:
1. Excision of chronic abscess pocket in the subxiphoid region of the epigastrium.
2. Excision of left thigh lipoma.
SURGEON: John Doe, MD
ANESTHESIA: General endotracheal.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Minimal.
SPECIMENS: Chronic subcutaneous abscess pocket and a large lipoma from the left thigh.
OPERATIVE FINDINGS: A chronic subcutaneous abscess pocket in the subxiphoid region from a previous midline incision. This appeared to be secondary to reaction to the PDS suture, that was closed at the fascial level, since the bottom of the abscess pocket contained within it the PDS suture. There was a well-defined cavity that was lined by granulation tissue.
DESCRIPTION OF OPERATION: The patient was identified in the holding area and brought to the operating suite, where she was placed in the supine position. General endotracheal anesthesia was induced without complications. Her abdomen was then prepped and draped in the usual sterile fashion.
An elliptical incision was made at the level of the skin around the chronic abscess cavity. Dissection was carried down to the subcutaneous tissue, being careful to stay outside the abscess cavity. This was carried all the way down to the level of the fascia. It was obvious that the cavity involved the top portion of the fascia. The fascia was then ellipsed around the abscess cavity. The abscess cavity appeared to have been excised in its entirety. Careful inspection within the cavity revealed partially dissolved PDS sutures at the bottom.
At this point, the wound was copiously irrigated and hemostasis was achieved. The fascial defect was closed with 0 nylon in interrupted figure-of-eight fashion. Next, the subcutaneous tissue was packed with saline-soaked gauze in anticipation of instituting a Wound-Evac postoperatively. Dressing was applied.
Next, the gloves and instrument trays were all changed. The left thigh was then prepped and draped in sterile manner. A skin incision was made overlying the lipoma. Dissection was carried down the subcutaneous tissue and the lipoma excised intact. This was a multilobulated lipoma.
The wound was copiously irrigated. The wound was then closed by reapproximating the subcutaneous tissue with 3-0 Vicryl followed by skin with 4-0 Vicryl in running subcuticular fashion. These were dressed with Steri-Strips. The patient was extubated at this point and taken to postanesthesia care unit in stable condition.
