CHIEF COMPLAINT: L dorsal wrist/hand defect from previous partial flap failure.

PRESENT ILLNESS: [**Known firstname 40658**] is a familiar patient to our hand
service. She, several months ago, had a subtotal incomplete
amputation followed by revascularization of the entire wrist
and hand, as well as open reduction of a very complex
disarticulation injury. She recently had coverage of exposed
plate on the dorsal aspect of the hand with a reversed dorsal
interosseous tissue flap. A portion of this did not survive,
namely the distal portion, and she comes back today for
coverage of residual area of exposed plate and carpal bones.
A free flap from the opposite forearm with primary closure of
the opposite forearm was chosen. The recipient vessels were
the radial artery in the mid forearm. Several days ago an
angiogram had documented the patency.

MEDICAL HISTORY: DM II,  HTN, Hypercholesterolemia

MEDICATION ON ADMISSION: Glyburide, norvasc, lipitor, advair

ALLERGIES: Tape

PHYSICAL EXAM: On Discharge
Alert and Oriented
RRR no murmurs
Lungs clear to auscultation
R forearm incision intact and without erythema.  Steri strips in
place.
L doral wrist with STSG in place without evidence of necrosis.
Splint in proper position.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone near [**Last Name (un) 17679**].  Works two jobs - factory in
evening, housecleaning in daytime.  Never smoked.  Does not
drink, no drug use.
Non-healing surgical wound,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obesity, unspecified
Non-healing surgcl wound,Abn react-surg proc NEC,Accident in place NEC,DMII wo cmp nt st uncntr,Hypertension NOS,Obesity NOS
Admission Date:  [**2122-7-30**]              Discharge Date:   [**2122-8-4**]

Date of Birth:  [**2057-12-2**]             Sex:   F

Service: PLASTIC

Allergies:
Tape

Attending:[**First Name3 (LF) 7733**]
Chief Complaint:
L dorsal wrist/hand defect from previous partial flap failure.

Major Surgical or Invasive Procedure:
1.  Free microvascular right radial forearm flap to dorsal
    aspect of left hand (microvascular).
2.  Plastic closure right forearm.
3.  Splint immobilization right and left forearms.
4.  Split-thickness skin graft left forearm.

History of Present Illness:
[**Known firstname 40658**] is a familiar patient to our hand
service. She, several months ago, had a subtotal incomplete
amputation followed by revascularization of the entire wrist
and hand, as well as open reduction of a very complex
disarticulation injury. She recently had coverage of exposed
plate on the dorsal aspect of the hand with a reversed dorsal
interosseous tissue flap. A portion of this did not survive,
namely the distal portion, and she comes back today for
coverage of residual area of exposed plate and carpal bones.
A free flap from the opposite forearm with primary closure of
the opposite forearm was chosen. The recipient vessels were
the radial artery in the mid forearm. Several days ago an
angiogram had documented the patency.


Past Medical History:
DM II,  HTN, Hypercholesterolemia

Social History:
Lives alone near [**Last Name (un) 17679**].  Works two jobs - factory in
evening, housecleaning in daytime.  Never smoked.  Does not
drink, no drug use.


Family History:
Non-contributory

Physical Exam:
On Discharge
Alert and Oriented
RRR no murmurs
Lungs clear to auscultation
R forearm incision intact and without erythema.  Steri strips in
place.
L doral wrist with STSG in place without evidence of necrosis.
Splint in proper position.

Brief Hospital Course:
Taken to the OR for free flap and STSG to L dorsal wrist.
Tolerated the procedure well, was extubated and transferred to
the floor without incident.  Dopplers were strong throughout the
hospital course.  Drain was removed on [**8-2**].  Was maintained on
abx.
[**8-3**] R hand dressing taken down. L hand dressing down and
changed.  Skin graft is taking well.  OOB walking without
assistance.
[**8-4**] was discharged from the hospital ambulating, tolerating
diet, and pain controlled.

Medications on Admission:
Glyburide, norvasc, lipitor, advair


Discharge Medications:
1. Keflex 500 mg Capsule Sig: One (1) Capsule PO four times a
day for 10 days.
Disp:*40 Capsule(s)* Refills:*0*
2. Percocet 5-325 mg Tablet Sig: 1-2 Tablets PO every 4-6 hours.
Disp:*40 Tablet(s)* Refills:*0*


Discharge Disposition:
Home With Service

Facility:
[**Hospital 56860**] nursing care

Discharge Diagnosis:
L wrist/hand defect from previous partial flap failure


Discharge Condition:
stable


Discharge Instructions:
Please return to the hospital if you experience fevers greater
then 101.4, chills, or other signs of infection. Also return to
the hospital if you experience chest pain, shortness of breath,
redness, swelling, or purulent discharge from the incision site.
Return if you experience worsening pain or any other concerning
symptoms.
Certain pain medications may have side effects such as
drowsiness. Do not operate heavy machinery while on these
medications.
Certain pain medications such as percocet or codeine can cause
constipation. If needed you can take a stool softner such as
Colace (one capsule) or gentle laxative (such as Milk of
Magnesia) once per day.
Restart taking all your regular medications once you arrive at
home.
.
Please resume previous medications as prior to your surgery.
Please take pain medications and stool softener as prescribed.
.
Please follow-up as directed.


Followup Instructions:
Follow up with Dr. [**Last Name (STitle) 5385**] in one week


                             [**First Name8 (NamePattern2) **] [**Last Name (NamePattern1) **] MD [**MD Number(1) 7738**]
{'Non-healing surgical wound,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obesity, unspecified'}


You are an AI assistant analyzing clinical admission notes from the MIMIC III dataset. Your task is to map symptoms mentioned in the notes to a list of provided ICD-9 LONG_TEXT.



### Clinical text :
CHIEF COMPLAINT: L dorsal wrist/hand defect from previous partial flap failure.

PRESENT ILLNESS: [**Known firstname 40658**] is a familiar patient to our hand
service. She, several months ago, had a subtotal incomplete
amputation followed by revascularization of the entire wrist
and hand, as well as open reduction of a very complex
disarticulation injury. She recently had coverage of exposed
plate on the dorsal aspect of the hand with a reversed dorsal
interosseous tissue flap. A portion of this did not survive,
namely the distal portion, and she comes back today for
coverage of residual area of exposed plate and carpal bones.
A free flap from the opposite forearm with primary closure of
the opposite forearm was chosen. The recipient vessels were
the radial artery in the mid forearm. Several days ago an
angiogram had documented the patency.

MEDICAL HISTORY: DM II,  HTN, Hypercholesterolemia

MEDICATION ON ADMISSION: Glyburide, norvasc, lipitor, advair

ALLERGIES: Tape

PHYSICAL EXAM: On Discharge
Alert and Oriented
RRR no murmurs
Lungs clear to auscultation
R forearm incision intact and without erythema.  Steri strips in
place.
L doral wrist with STSG in place without evidence of necrosis.
Splint in proper position.

FAMILY HISTORY: Non-contributory

SOCIAL HISTORY: Lives alone near [**Last Name (un) 17679**].  Works two jobs - factory in
evening, housecleaning in daytime.  Never smoked.  Does not
drink, no drug use. 

### Response:
{'Non-healing surgical wound,Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation,Accidents occurring in other specified places,Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled,Unspecified essential hypertension,Obesity, unspecified'}
