Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure
CPT4 code
Name of the Procedure:
Debridement of Skin, Subcutaneous Tissue, Muscle, and Fascia for Necrotizing Soft Tissue Infection (NSTI); External Genitalia, Perineum, and Abdominal Wall, with or without Fascial Closure.
Summary
Debridement for necrotizing soft tissue infection is a surgical procedure that removes infected and dead tissue from areas such as the external genitalia, perineum, or abdominal wall. This is crucial to prevent the spread of the infection and to promote healing.
Purpose
The purpose of this procedure is to treat necrotizing soft tissue infections, a severe bacterial infection that can rapidly destroy skin, fat, and muscle tissue. The goal is to remove the infected tissue to stop the infection from spreading, prevent sepsis, and enable the body to heal.
Indications
- Rapidly spreading skin infection with symptoms such as severe pain, fever, and redness.
- Necrosis (tissue death) visible on imaging or during clinical examination.
- Signs of systemic infection such as a high white blood cell count, fever, and hypotension.
- Patients who do not respond to antibiotic therapy alone.
Preparation
- Patients may be required to fast for a certain period before the procedure.
- Medication adjustments may be necessary, for example, stopping blood thinners.
- Preoperative assessments could include blood tests, imaging studies (like CT scans), and consultation with an infectious disease specialist.
Procedure Description
- The procedure is performed under general anesthesia.
- An incision is made to access the infected area.
- The surgeon systematically removes all necrotic (dead) tissue including skin, subcutaneous tissue, muscle, and fascia as needed.
- The area is thoroughly irrigated and cleaned to minimize the bacterial load.
- Depending on the extent of tissue removal, the surgeon may close the wound or leave it open to be managed with wound dressings.
- In cases where the fascial closure is performed, the remaining tissue is approximated and sutured.
Tools and equipment used include scalpels, surgical scissors, forceps, suction devices, and irrigation systems.
Duration
The procedure typically takes between 1 to 3 hours, depending on the extent of the infection and the area being treated.
Setting
This surgery is generally performed in a hospital operating room due to the need for general anesthesia and a sterile environment.
Personnel
- A surgical team composed of a general or specialized surgeon.
- An anesthesiologist or nurse anesthetist.
- Surgical nurses and operating room technicians for assistance.
Risks and Complications
Common risks:
- Bleeding
- Infection at the surgical site
- Pain and swelling
Rare complications:
- Sepsis
- Organ failure due to severe systemic infection
- Need for further surgical procedures
- Adverse reactions to anesthesia
Benefits
- Rapid halt of infection spread
- Prevention of life-threatening complications like sepsis
- Enhanced likelihood of recovery and wound healing
The benefits can be immediate in halting the spread of infection, though complete healing may take several weeks.
Recovery
- Post-procedure care includes wound management, which may involve frequent dressing changes and possibly additional debridement sessions.
- Pain management will be addressed often with prescription medications.
- Antibiotics are typically continued to address any residual infection.
- A follow-up schedule with the healthcare provider for wound assessment and monitoring healing progress.
- Full recovery may take several weeks to months, depending on the infection severity and patient’s overall health.
Alternatives
- Non-surgical management using antibiotics alone, though typically less effective in severe cases.
- Hyperbaric oxygen therapy, which can be used as adjuvant therapy but not as a sole treatment.
- Pros and cons: Surgical debridement provides immediate removal of infected tissue, whereas non-surgical options may not sufficiently halt fast-progressing infections.
Patient Experience
During the procedure:
- The patient will be under general anesthesia and should not feel pain during the surgery.
After the procedure:
- Patients may experience discomfort, manageable with pain medication.
- Possible use of wound care products such as dressings and antibacterial ointments.
- Mobility may be limited depending on the affected area, and assistance may be needed for activities of daily living temporarily.
- Continuous monitoring for signs of infection recurrence or complications.
Pain management and comfort measures will include prescribed medication and careful wound care instructions.