DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSES:
1. Open sternal wound.
2. History of left non-small cell lung cancer.
3. Status post left intrapericardial pneumonectomy.
4. History of right upper lobe non-small cell lung cancer.
5. Status post median sternotomy and right upper lobe wedge resection.
POSTOPERATIVE DIAGNOSES:
1. Open sternal wound.
2. History of left non-small cell lung cancer.
3. Status post left intrapericardial pneumonectomy.
4. History of right upper lobe non-small cell lung cancer.
5. Status post median sternotomy and right upper lobe wedge resection.
PROCEDURES PERFORMED:
1. Irrigation and debridement of the sternum.
2. Bilateral pectoralis myocutaneous advancement flaps.
3. Closure of the sternal wound.
4. Bronchoscopy.
SURGEON: John Doe, MD
INDICATIONS FOR PROCEDURE: The patient is a (XX)-year-old woman with a history of left lung cancer treated by pneumonectomy. She had a new primary over two years later that was treated by sternotomy and wedge resection. She initially did well but was readmitted with sepsis and subsequently developed a sternal wound infection. Two days ago, we opened the sternum and debrided it. She has been treated with dressing changes for two days and is brought back now to the operating room.
DESCRIPTION OF PROCEDURE: Briefly, the patient was brought to the operating room intubated from the intensive care unit. The patient’s anterior chest was prepped and draped. The VAC sponge had been removed prior to prepping. The edge of the sternum was then debrided with curettes and appeared to be well vascularized without active infection.
Bilateral pectoralis myocutaneous flaps were then elevated to the point that they could be reapproximated at midline without undue tension. We did not feel that closing the sternum was necessary or ideal considering her infection, but we felt that flap coverage was a reasonable approach.
After using the Pulsavac to irrigate the wound and assuring hemostasis, two 19-French Blake drains were placed underneath the flap sites and one was placed in the sternal wound. The flaps were then advanced and closed together at midline with interrupted 2-0 PDS sutures. The subcutaneous tissue was then closed with 3-0 Vicryl, and the skin was closed with interrupted nylon mattress sutures. Dressings were placed, and the patient was brought back to the surgical intensive care unit hemodynamically stable and still vented.
