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Intraoperative Bleed with treatment by Gelfoam with Thrombin

Date: Jan 26, 2023


Male w/infected LT knee was in operative suite when I was called. Had exposure on anterior surface of LT knee & incision in below-knee area on medial aspect of proximal LT calf. Ortho surgeon had been evacuating the area of infection when he noticed bleeding behind the tibia. When I arrived patient had a tourniquet insufflated to 300 mmHg. We let this down & noticed bleeding posterior to proximal LT tibia. I extended incision about a half a CM proximally. Upon doing this, was noted patient had significant venous pressure. By extending incision I was able to see into the depth of the wound better. All bleeding appeared venous in nature. I took Gelfoam soaked in thrombin & packed the area. Tourniquet reinsufflated to 300 mmHg. We left this in position for 10 minutes. Tourniquet released, no evidence of active arterial bleed. Good Doppler signal over DP, no signal over PT. No active pulsatile bleed from knee incision. Gelfoam & thrombin left in position. Ortho surgeon closed incision. Should I code only an E/M for my vascular surgeon's work?

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