Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular)
CPT4 code
Name of the Procedure:
Partial Excision of the Wing of Ilium, Symphysis Pubis, or Greater Trochanter of Femur (also known as Craterization or Saucerization)
Summary
This surgical procedure involves the removal of a portion of the bone from the ilium, symphysis pubis, or greater trochanter of the femur. It is typically performed to treat conditions like osteomyelitis or bone abscesses. The aim is to excise infected or dead bone tissue to promote healing and prevent the spread of infection.
Purpose
The procedure primarily addresses osteomyelitis (bone infection) or bone abscesses. The goals are to remove infected or necrotic bone, reduce pain, and promote the healing of the affected bone and surrounding tissue.
Indications
- Persistent bone infection (osteomyelitis)
- Bone abscesses not responding to antibiotic treatment
- Evidence of necrotic (dead) bone tissue
- Swelling, redness, and pain in the affected area
- Recurrent or chronic bone infections
Preparation
- Pre-operative fasting as instructed by the medical team
- Discontinuation of certain medications such as blood thinners, as advised
- Pre-procedure diagnostic imaging (MRI, CT scan) and blood tests to assess the extent of infection
- Consultation with an anesthesiologist
Procedure Description
- The patient is given general anesthesia.
- An incision is made over the affected bone area.
- The surgeon identifies and isolates the infected or necrotic bone.
- The surgeon uses specialized tools to carefully remove the affected portion of the bone.
- The area is thoroughly cleaned to remove any remaining infected tissue.
- If necessary, a bone graft or other reconstructive technique is used to stabilize the area.
- The incision is closed with sutures and the area is bandaged.
Duration
The procedure typically takes 1 to 3 hours, depending on the extent of the infection and the complexity of the case.
Setting
The procedure is performed in a hospital's surgical department or an outpatient surgical center.
Personnel
- Orthopedic surgeon or general surgeon
- Anesthesiologist
- Surgical nurses
- Scrub techs and surgical assistants
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Nerve damage
- Delayed wound healing
- Recurrence of infection
- Pain or discomfort at the surgical site
Benefits
- Removal of infected or dead bone tissue
- Reduced pain and inflammation
- Prevention of further spread of infection
- Enhanced healing and recovery of the bone
Recovery
- Post-procedure pain management includes prescribed pain relief medications.
- Antibiotics may be administered to prevent or treat infection.
- Instructions for wound care and activity restrictions are provided.
- Physical therapy might be needed to restore function and mobility.
- Follow-up appointments assess recovery and ensure no recurrence of infection.
- Typical recovery period ranges from a few weeks to several months, depending on the severity and complexity of the case.
Alternatives
- Long-term antibiotic therapy (though less effective for extensive infections)
- Aspiration and drainage of abscesses
- Hyperbaric oxygen therapy for osteomyelitis
- Each alternative has varying pros and cons, with surgical intervention often providing more definitive resolution of severe infections.
Patient Experience
- The patient will be under general anesthesia and will not feel pain during the procedure.
- Post-procedure pain and discomfort managed with medication.
- Initial rest and limited activity are required, followed by gradual return to normal activities under medical supervision.
- Some soreness and swelling are expected but should subside with time and proper care.