Skin and Soft Tissue Infection · Skin and Soft Tissue Infection Skin and Soft Tissue Infection Epidermis: Erysipelas, Impetigo, Folliculitis, Ectyma, Carbuncle Dermis: Cellulitis
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นพ.บริรักษ์ เจริญศิลป์ กลุ่มงานศัลยกรรม รพ.สวรรค์ประชารักษ์ นครสวรรค์
Chapter XII L00-L99 Skin and Subcutaneous Tissue
บันทึกการวินิจฉัยรอยโรคท่ีรุนแรงสุด หรือ เนื้อเยื่อชั้นลึกสุด
ระบุตำแหน่งทางกายวิภาคของรอยโรค หรือ ชนิดเนื้อเยื่อเฉพาะ
ระบุสาเหตุของการอักเสบติดเชื้อ
ระบุเชื้อก่อโรค
Skin and Soft Tissue Infection
Skin and Soft Tissue Infection
Epidermis: Erysipelas, Impetigo, Folliculitis, Ectyma, Carbuncle
Dermis: Cellulitis
Subcutaneous fat: Necrotizing fasciitis
Muscle: Pyomyositis
Cellulitis
Summary Diagnosis ICD-10Erysipelas A46
Cellulitis
following immunization
at drainage site
at auricle/external auditory canal
at penis
at other sites
!T88.0
T81.4
H60.1
N48.2
L03.-
Lymphangitis I89.1
Gas gangrene, Clostridial cellulitis A48.0
Necrotizing fasciitis M72.6-
Cellulitis
Version for 2010 497
L03 Cellulitis Includes: acute lymphangitis Excludes: cellulitis of:
· anal and rectal regions ( K61.- ) · external auditory canal ( H60.1 ) · external genital organs: · female ( N76.4 ) · male ( N48.2 , N49.- ) · eyelid ( H00.0 ) · lacrimal apparatus ( H04.3 ) · mouth ( K12.2 ) · nose ( J34.0 ) eosinophilic cellulitis [Wells] ( L98.3 ) febrile neutrophilic dermatosis [Sweet] ( L98.2 ) lymphangitis (chronic)(subacute) ( I89.1 )
L03.0 Cellulitis of finger and toe Infection of nail
Onychia Paronychia Perionychia
L03.1 Cellulitis of other parts of limb Axilla
Hip Shoulder
L03.2 Cellulitis of face L03.3 Cellulitis of trunk Abdominal wall
Back [any part] Chest wall Groin Perineum Umbilicus
Excludes: omphalitis of newborn ( P38 ) L03.8 Cellulitis of other sites Head [any part, except face]
Scalp L03.9 Cellulitis, unspecified
Version for 2010 497
L03 Cellulitis Includes: acute lymphangitis Excludes: cellulitis of:
· anal and rectal regions ( K61.- ) · external auditory canal ( H60.1 ) · external genital organs: · female ( N76.4 ) · male ( N48.2 , N49.- ) · eyelid ( H00.0 ) · lacrimal apparatus ( H04.3 ) · mouth ( K12.2 ) · nose ( J34.0 ) eosinophilic cellulitis [Wells] ( L98.3 ) febrile neutrophilic dermatosis [Sweet] ( L98.2 ) lymphangitis (chronic)(subacute) ( I89.1 )
L03.0 Cellulitis of finger and toe Infection of nail
Onychia Paronychia Perionychia
L03.1 Cellulitis of other parts of limb Axilla
Hip Shoulder
L03.2 Cellulitis of face L03.3 Cellulitis of trunk Abdominal wall
Back [any part] Chest wall Groin Perineum Umbilicus
Excludes: omphalitis of newborn ( P38 ) L03.8 Cellulitis of other sites Head [any part, except face]
Scalp L03.9 Cellulitis, unspecified
Abscess
Summary Diagnosis ICD-10Abscess at
eyelid
nose, nasal septum
auricle, external auditory canal
preauricular sinus
other sites
furuncle, carbuncle]
!H00.0
J34.0
H60.0
Q18.1
L02.-
Breast abscess
Breast abscess in puerperium / Postpartum breast abscess
N61
O91.0
Anorectal abscess
Pilonidal abscess
K61.-
L05.0
Abscess
Summary Diagnosis ICD-10Bartholin’s abscess
Bartholin’s abscess in pregnancy
Bartholin’s abscess in puerperium
N75.1
O23.5
O86.1
Abscess at surgical wound, stitch abscess T81.0
Hiadradenitis suppurativa
Sebaceous cyse abscess
Epidermal inclusion cyst abscess
L73.2
L73.2
L72.0
Wound / Ulcer / Gangrene
Version for 2010 519
L95 Vasculitis limited to skin, not elsewhere classified Excludes: angioma serpiginosum ( L81.7 )
Henoch(-Schönlein) purpura ( D69.0 ) hypersensitivity angiitis ( M31.0 ) panniculitis (of): · NOS ( M79.3 ) · lupus ( L93.2 ) · neck and back ( M54.0 ) · relapsing [Weber-Christian] ( M35.6 )
polyarteritis nodosa ( M30.0 ) rheumatoid vasculitis ( M05.2 ) serum sickness ( T80.6 ) urticaria ( L50.- ) Wegener's granulomatosis ( M31.3 )
L95.0 Livedoid vasculitis Atrophie blanche (en plaque) L95.1 Erythema elevatum diutinum L95.8 Other vasculitis limited to skin L95.9 Vasculitis limited to skin, unspecified L97 Ulcer of lower limb, not elsewhere classified Excludes: decubitus [pressure] ulcer and pressure area ( L89.- )
gangrene ( R02 ) skin infections ( L00-L08 ) specific infections classified to A00-B99 varicose ulcer ( I83.0 , I83.2 )
L98 Other disorders of skin and subcutaneous tissue, not elsewhere classified L98.0 Pyogenic granuloma L98.1 Factitial dermatitis Neurotic excoriation L98.2 Febrile neutrophilic dermatosis [Sweet] L98.3 Eosinophilic cellulitis [Wells]
520 WHO’s ICD-10
L98.4 Chronic ulcer of skin, not elsewhere classified Chronic ulcer of skin NOS
Tropical ulcer NOS Ulcer of skin NOS
Excludes: decubitus [pressure] ulcer and pressure area ( L89.- ) gangrene ( R02 ) skin infections (L00-L08 ) specific infections classified to A00-B99 ulcer of lower limb NEC ( L97 ) varicose ulcer ( I83.0 , I83.2 )
L98.5 Mucinosis of skin Focal mucinosis
Lichen myxoedematosus Excludes: focal oral mucinosis ( K13.7 )
myxoedema ( E03.9 ) L98.6 Other infiltrative disorders of skin and subcutaneous tissue Excludes: hyalinosis cutis et mucosae ( E78.8 ) L98.8 Other specified disorders of skin and subcutaneous tissue L98.9 Disorder of skin and subcutaneous tissue, unspecified L99* Other disorders of skin and subcutaneous tissue in diseases classified elsewhere L99.0* Amyloidosis of skin ( E85.-† ) Lichen amyloidosis
Macular amyloid L99.8* Other specified disorders of skin and subcutaneous tissue in
diseases classified elsewhere Syphilitic:
· alopecia ( A51.3† ) · leukoderma ( A51.3† , A52.7† )
Wound / Ulcer / Gangrene
Version for 2010 883
T79.0 Air embolism (traumatic) Excludes: air embolism complicating:
· abortion or ectopic or molar pregnancy ( O00-O07 , O08.2 )· pregnancy, childbirth and the puerperium ( O88.0 )
T79.1 Fat embolism (traumatic) Excludes: fat embolism complicating:
· abortion or ectopic or molar pregnancy ( O00-O07 , O08.2 )· pregnancy, childbirth and the puerperium ( O88.8 )
T79.2 Traumatic secondary and recurrent haemorrhage
T79.3 Post-traumatic wound infection, not elsewhere classified Use additional code (B95-B97), if desired, to identify infectious agent. T79.4 Traumatic shock Shock (immediate)(delayed) following injury Excludes: shock:
· anaesthetic ( T88.2 ) · anaphylactic: · NOS ( T78.2 ) · due to: · adverse food reaction ( T78.0 ) · correct medicinal substance properly administered ( T88.6 ) · serum ( T80.5 ) · complicating abortion or ectopic or molar pregnancy ( O00-O07 , O08.3 ) · electric ( T75.4 ) · lightning ( T75.0 ) · nontraumatic NEC ( R57.- ) · obstetric ( O75.1 ) · postoperative ( T81.1 )
T79.5 Traumatic anuria Crush syndrome
Renal failure following crushing
T79.6 Traumatic ischaemia of muscle Compartment syndrome
Volkmann's ischaemic contracture Excludes: anterior tibial syndrome ( M76.8 )
888 WHO’s ICD-10
T81.3 Disruption of operation wound, not elsewhere classified Dehiscence
Rupture } of operation wound
Excludes: disruption of: · caesarean-section wound ( O90.0 ) · perineal obstetric wound ( O90.1 )
T81.4 Infection following a procedure, not elsewhere classified Abscess:
· intra-abdominal · stitch · subphrenic · wound Sepsis
postprocedural
Use additional code, if desired, to identify other manifestations of infection, such as sepsis or abscess.
Excludes: infection due to: · infusion, transfusion and therapeutic injection ( T80.2 ) · prosthetic devices, implants and grafts ( T82.6-T82.7 , T83.5-T83.6 , T84.5-T84.7 , T85.7 ) obstetric surgical wound infection ( O86.0 )
T81.5 Foreign body accidentally left in body cavity or operation wound following a procedure
Adhesions Obstruction Perforation due to foreign body accidentally left in
operation wound or body cavity
Excludes: obstruction or perforation due to prosthetic devices and implants intentionally left in body ( T82.0-T82.5 , T83.0-T83.4 , T84.0-T84.4 , T85.0-T85.6 )
T81.6 Acute reaction to foreign substance accidentally left during a procedure
Peritonitis: · aseptic · chemical
Wound / Ulcer / Gangrene
Version for 2010 895
T87 Complications peculiar to reattachment and amputation T87.0 Complications of reattached (part of) upper extremity
T87.1 Complications of reattached (part of) lower extremity
T87.2 Complications of other reattached body part
T87.3 Neuroma of amputation stump
T87.4 Infection of amputation stump
T87.5 Necrosis of amputation stump
T87.6 Other and unspecified complications of amputation stump Amputation stump:
· contracture (flexion)(of next proximal joint) · haematoma · oedema
Excludes: phantom limb syndrome ( G54.6-G54.7 ) T88 Other complications of surgical and medical care, not elsewhere classified Excludes: accidental puncture or laceration during a procedure
( T81.2 ) complications following: · infusion, transfusion and therapeutic injection ( T80.- ) · procedure NEC ( T81.- ) specified complications classified elsewhere, such as: · complications of: · anaesthesia in: · labour and delivery ( O74.- ) · pregnancy ( O29.- ) · puerperium ( O89.- ) · devices, implants and grafts ( T82-T85 ) · obstetric surgery and procedures ( O75.4 ) · dermatitis due to drugs and medicaments ( L23.3 , L24.4 , L25.1 , L27.0-L27.1 ) · poisoning and toxic effects of drugs and chemicals ( T36-T65 )
Wound / Ulcer / Gangrene
412 WHO’s ICD-10
I83 Varicose veins of lower extremities Excludes: complicating:
· pregnancy ( O22.0 ) · puerperium ( O87.8 )
I83.0 Varicose veins of lower extremities with ulcer Any condition in I83.9 with ulcer or specified as ulcerated
Varicose ulcer (lower extremity, any part) I83.1 Varicose veins of lower extremities with inflammation Any condition in I83.9 with inflammation or specified as
inflamed Stasis dermatitis NOS I83.2 Varicose veins of lower extremities with both ulcer and
inflammation Any condition in I83.9 with both ulcer and inflammation I83.9 Varicose veins of lower extremities without ulcer or
inflammation Phlebectasia
Varicose veins Varix } of lower extremity [any part] or of
unspecified site
I84 Haemorrhoids Includes: piles
varicose veins of anus and rectum Excludes: complicating:
· childbirth and the puerperium ( O87.2 ) · pregnancy ( O22.4 )
I84.0 Internal thrombosed haemorrhoids I84.1 Internal haemorrhoids with other complications Internal haemorrhoids:
· bleeding · prolapsed · strangulated · ulcerated
I84.2 Internal haemorrhoids without complication Internal haemorrhoids NOS I84.3 External thrombosed haemorrhoids Perianal thrombosis
Perianal haematoma (nontraumatic)
516 WHO’s ICD-10
L87.8 Other transepidermal elimination disorders L87.9 Transepidermal elimination disorder, unspecified
L88 Pyoderma gangrenosum Dermatitis gangrenosa
Phagedenic pyoderma
L89 Decubitus ulcer and pressure area Bedsore
Plaster ulcer Note: For multiple sites of differing stages assign only one
code indicating the highest stage. Excludes: decubitus (trophic) ulcer of cervix (uteri) ( N86 ) L89.0 Stage I decubitus ulcer and pressure area� Decubitus [pressure] ulcer limited to erythema only Note: The ulcer appears as a defined area of persistent redness
(erythema) in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues, without skin loss.
L89.1 Stage II decubitus ulcer� Decubitus [pressure] ulcer with:
•abrasion •blister •partial thickness skin loss involving epidermis and/or dermis •skin loss NOS
L89.2 Stage III decubitus ulcer� Decubitus [pressure] ulcer with full thickness skin loss
involving damage or necrosis of subcutaneous tissue extending to underlying fascia
L89.3 Stage IV decubitus ulcer� Decubitus [pressure] ulcer with necrosis of muscle, bone or
supporting structures (ie tendon or joint capsule) L89.9 Decubitus ulcer and pressure area, unspecified� Decubitus [pressure] ulcer without mention of stage
L90 Atrophic disorders of skin L90.0 Lichen sclerosus et atrophicus Excludes: lichen sclerosus of external genital organs:
· female (N90.4) · male (N48.0)
Wound / Ulcer / Gangrene
Version for 2010 405
I69.2 Sequelae of other nontraumatic intracranial haemorrhage
I69.3 Sequelae of cerebral infarction I69.4 Sequelae of stroke, not specified as haemorrhage or infarction
I69.8 Sequelae of other and unspecified cerebrovascular diseases
Diseases of arteries, arterioles and capillaries (I70-I79) I70 Atherosclerosis Includes: arteriolosclerosis
arteriosclerosis arteriosclerotic vascular disease atheroma degeneration: · arterial · arteriovascular · vascular endarteritis deformans or obliterans senile: · arteritis · endarteritis
The following supplementary classification to indicate the presence or absence of gangrene is provided for optional use. 0 without gangrene� 1 with gangrene�
Excludes: cerebral ( I67.2 ) coronary ( I25.1 ) mesenteric ( K55.1 ) pulmonary ( I27.0 )
I70.0 Atherosclerosis of aorta I70.1 Atherosclerosis of renal artery Goldblatt's kidney Excludes: atherosclerosis of renal arterioles ( I12.- ) I70.2 Atherosclerosis of arteries of extremities Atherosclerotic gangrene
Mönckeberg's (medial) sclerosis I70.8 Atherosclerosis of other arteries I70.9 Generalized and unspecified atherosclerosis
Wound / Ulcer / Gangrene
746 WHO’s ICD-10
R00.1 Bradycardia, unspecified Bradycardia:
· sinoatrial · sinus · vagal Slow heart beat
Use additional external cause code (Chapter XX), if desired, to identify drug, if drug-induced.
R00.2 Palpitations Awareness of heart beat
R00.8 Other and unspecified abnormalities of heart beat
R01 Cardiac murmurs and other cardiac sounds Excludes: those originating in the perinatal period ( P29.8 ) R01.0 Benign and innocent cardiac murmurs Functional cardiac murmur
R01.1 Cardiac murmur, unspecified Cardiac bruit NOS
R01.2 Other cardiac sounds Cardiac dullness, increased or decreased
Precordial friction R02 Gangrene, not elsewhere classified Excludes: gangrene in:
· atherosclerosis ( I70.2 ) · diabetes mellitus ( E10-E14 with common fourth character .5) · other peripheral vascular diseases ( I73.- ) gangrene of certain specified sites - see Alphabetical Index gas gangrene ( A48.0 ) pyoderma gangrenosum ( L88 )
Wound / Ulcer / Gangrene
Summary Diagnosis ICD-10Infected wound
Surgical wound
Surgical wound
Amputated stump
Pressure sore
Traumatic wound
!T81.4
T85.7
T87.4
L89.-
T79.3
Ulcer
Arterial ulcer
Venous ulcer
Unknown caused
!I70.20
I83.0 / I83.2
L97
L98.4
Wound / Ulcer / Gangrene
Summary Diagnosis ICD-10Gangrene
Diabetic angiopathy, Diabetic gangrene
Atherosclerosis
Unknown caused
!E11.5
I70.21
R02
Lymphangitis
Lymphangitis Lymphadenitis
Lymphadenitis
Lymphangitis Lymphadenitis
Lymphangitis LymphadenitisSummary Diagnosis ICD-10
Lymphangitis
Acute lymphangitis
Chronic lymphangitis
I89.1
L03.-
I89.1
Lymphadenitis
Acute lymphadenitis
Chronic lymphadenitis
Mesenteric lymphadenitis
Tuberculous lymphadenitis
Mesenteric tuberculous lymphadenitis
O91.2
L04.-
I88.1
I88.0
A18.2
A18.3 + K93.0
Phlebitis
Summary Diagnosis ICD-10
Phlebitis
Phlebitis of upper extremity
Phlebitis of lower extremity
Superficial phlebitis of lower extremity
Phlebitis of femoral vein
Deep vein thrombosis
Deep vein thrombosis of femoral vein
I80.9
I80.8
I80.3
I80.0
I80.1
I80.2
I80.1
Lymphadenopathy
766 WHO’s ICD-10
R57.0 Cardiogenic shock
R57.1 Hypovolaemic shock
R57.2 Septic shock�
R57.8 Other shock Endotoxic shock
R57.9 Shock, unspecified Failure of peripheral circulation NOS
R58 Haemorrhage, not elsewhere classified Haemorrhage NOS
R59 Enlarged lymph nodes Includes: swollen glands Excludes: lymphadenitis:
· NOS ( I88.9 ) · acute ( L04.- ) · chronic ( I88.1 ) · mesenteric (acute)(chronic) ( I88.0 )
R59.0 Localized enlarged lymph nodes
R59.1 Generalized enlarged lymph nodes Lymphadenopathy NOS Excludes: HIV disease resulting in (persistent) generalized
lymphadenopathy ( B23.1 )
R59.9 Enlarged lymph nodes, unspecified
R60 Oedema, not elsewhere classified Excludes: ascites ( R18 )
hydrops fetalis NOS ( P83.2 ) hydrothorax ( J94.8 ) oedema (of): · angioneurotic ( T78.3 ) · cerebral ( G93.6 ) · due to birth injury ( P11.0 ) · gestational ( O12.0 )
Lymphadenopathy คือ ต่อมน้ำเหลืองขนาดโตกว่า 1 เซนติเมตร
เป็นเวลานานกว่า 2 สัปดาห์ [epitrochear >0.5 cm, inguinal >1.5 cm]
Generalized lymphadenopathy
: ต่อมน้ำเหลืองโตในบริเวณต่างกัน ตั้งแต่สองตำแหน่งขึ้นไป
Localized lymphadenopathy
: ต่อมนำ้เหลืองโตในบริเวณเดียวกัน
ให้ระบุสาเหตุของต่อมน้ำเหลืองโตเป็นการวินิจฉัย
Lymphadenopathy
Persistent generalized lymphadenopathy [PGL] due to HIV
เป็นต่อมน้ำเหลืองตั้งแต่สองตำแหน่งขึ้นไป [ไม่รวมที่ขาหนีบ]
และต่อมน้ำเหลืองทั้งสองตำแหน่งต้องเชื่อมต่อกัน (draining chain)
ต่อมน้ำเหลืองต้องโตกว่า 1 เซนติเมตร และโตอยู่นานกว่า 1 เดือน
เมื่อตัดชิ้นเนื้อไปตรวจจะไม่ใช่จากการติดเชื้อหรือเป็นมะเร็งของ
ต่อมน้ำเหลือง
พบในระยะที่ 3 ของการติดเชื้อเอสไอวี
Lymphadenopathy
Congenital toxoplasmosis
เกิดในทารก มีการติดเชื้อของอวัยวะทั่วร่างกาย เช่น pneumonia,
myocarditis, hepatitis, chorioretinitis, hydrocephalus
Toxoplasma lymphadenitis
ผู้ป่วยจะมีไข้ ต่อมน้ำเหลืองโต โดยเฉพาะที่คอและหลังหู รวมถึง
มีการติดเชื้อของอวัยวะอื่นร่วมด้วย
ยืนยันวินิจฉัยโดยตรวจพบเชื้อ toxoplasma gondii หรือการตรวจ
หาปฏิกิริยาภูมิต้านทานต่อเชื้อ เช่น ELISA, indirect hemagglutination test, complement fixation, IgM antibodies
Lymphadenopathy Lymphadenopathy
Summary Diagnosis ICD-10Lymphadenopathy
Generalized lymphadenopathy
Localized lymphadenopathy
R57.1
R57.1
R57.0
Persistent generalized lymphadenopathy in HIV disease
Toxoplasma lymphadenitis
Congenital toxoplasmosis
B23.1
B58.8
P37.1
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brushing irrigation (under pressure) scrubbing washing
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brushing irrigation (under pressure) scrubbing washing
Water scalpel (jet)
บันทึกรายงานการทำหัตถการ
: รายละเอียดพยาธิสภาพว่า มีเนื้อตายที่จำเป็นต้องตัดเลาะออก
ไม่ใช่ บันทึกชื่อการวินิจฉัยโรค
: รายละเอียดของหัตถการว่า มีการตัดเลาะเนื้อเยื่อออกจริง
ไม่ใช่ บันทึกชื่อหัตถการ
: บันทึกหัตถการว่า Excisional debridement
หากไม่ครบตามเกณฑ์ทั้งสามข้อ ให้ถือว่าเป็น Debridement
กรณีเป็นเนื้อเยื่อที่มีความจำเพาะ ให้ระบุชนิดของเนื้อเยื่อนั้น
Excisional Debridement Debridement vs Excisional D’
Summary Procedure ICD-9-CMDebridement
Excisional debridement
88.28
86.22
Debridement or Excisional debridement of
open fracture of
infected
open fracture of skull
infected skull
!79.6-
77.6-
02.02
01.25
Debridement of [if suture or repair, not coding]
muscle
muscle at hand
tendon or fascia
!83.45
82.36
83.39
Debridement vs Excisional D’
Summary Procedure ICD-9-CMDebridement or Excisional debridement of
abdominal wall
brain
nail, nail fold
flap
!54.3
01.59
86.27
86.75
คำวินิจฉัยอื่น bed sore, decubitus ulcer
ความรุนแรงของแผล
: ระยะที่ 1 รอยแดงที่กดไม่จางลง รอยช้ำในผิวสีคล้ำ
: ระยะที่ 2 ถลอก ตุ่มพอง
: ระยะที่ 3 ผิวหนังตาย หลุดลอก
: ระยะที่ 4 ลึกถึงกล้ามเนื้อ เอ็น ปลอกหุ้มข้อ ข้อ กระดูก
Pressure sore = Infected pressure sore
Pressure Sore
Pressure Sore
516 WHO’s ICD-10
L87.8 Other transepidermal elimination disorders L87.9 Transepidermal elimination disorder, unspecified
L88 Pyoderma gangrenosum Dermatitis gangrenosa
Phagedenic pyoderma
L89 Decubitus ulcer and pressure area Bedsore
Plaster ulcer Note: For multiple sites of differing stages assign only one
code indicating the highest stage. Excludes: decubitus (trophic) ulcer of cervix (uteri) ( N86 ) L89.0 Stage I decubitus ulcer and pressure area� Decubitus [pressure] ulcer limited to erythema only Note: The ulcer appears as a defined area of persistent redness
(erythema) in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue or purple hues, without skin loss.
L89.1 Stage II decubitus ulcer� Decubitus [pressure] ulcer with:
•abrasion •blister •partial thickness skin loss involving epidermis and/or dermis •skin loss NOS
L89.2 Stage III decubitus ulcer� Decubitus [pressure] ulcer with full thickness skin loss
involving damage or necrosis of subcutaneous tissue extending to underlying fascia
L89.3 Stage IV decubitus ulcer� Decubitus [pressure] ulcer with necrosis of muscle, bone or
supporting structures (ie tendon or joint capsule) L89.9 Decubitus ulcer and pressure area, unspecified� Decubitus [pressure] ulcer without mention of stage
L90 Atrophic disorders of skin L90.0 Lichen sclerosus et atrophicus Excludes: lichen sclerosus of external genital organs:
· female (N90.4) · male (N48.0)
ระยะที่ 1 รอยแดงที่ไม่จางลง รอยช้ำในผิวคล้ำ ระยะที่ 2 ถลอก ตุ่มพอง [ผิวหนังบางส่วนหลุดลอก] ระยะที่ 3 ผิวหนังตาย หลุดลอก [รวมชั้น fascia] ระยะที่ 4 กล้ามเนื้อ เอ็น ปลอกหุ้มข้อ ข้อ กระดูก
Pressure Sore
Summary Diagnosis ICD-10Pressure sore
Pressure sore stage I
Pressure sore stage II
Pressure sore stage III
Pressure sore stage IV
L89.9
L89.0
L89.1
L89.2
L89.3
ผู้ป่วยเป็นอัมพาตครึ่งซีกซ้าย มาด้วยแผลเรื้อรังที่ก้นกบ มีหนองไหลกลิ่นเหม็น นานกว่า 2 เดือน ตรวจพบแผลลึกถึงกระดูก
แพทย์วินิจฉัยว่า chronic osteomyelitis
PDx Chronic osteomyelitis at sacrum M86.65
SDxOld CVA Z86.7
PDx Decubitus ulcer stage IV L89.3
SDxSequelae of CVA Flaccid left hemiplegia
I69.2 G81.0
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