Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus
CPT4 code
Name of the Procedure:
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) of a tarsal or metatarsal bone – excluding the talus or calcaneus
Summary
A partial excision involves removing a portion of the bone in the foot, specifically the tarsal or metatarsal bones, to treat conditions like chronic infections or abnormal bone growths. It is performed to alleviate pain and prevent further complications.
Purpose
The procedure aims to address issues such as osteomyelitis (bone infection) or bossing (bone protrusion). The goal is to remove the infected or problematic section of the bone, relieve pain, and restore normal function and anatomy.
Indications
- Chronic osteomyelitis of the tarsal or metatarsal bones
- Persistent pain due to bone bossing or abnormal growths
- Non-responsive to conservative treatments like antibiotics or physical therapy
- Radiographic evidence of bone sequesters or necrosis
Preparation
- Patients may be required to fast for a specified period before the procedure.
- Discontinue certain medications, such as blood thinners, according to physician instructions.
- Preoperative imaging studies like X-rays, MRI, or CT scans to assess the extent of the condition.
- Blood tests to ensure good health status before surgery.
Procedure Description
- The patient is put under general or regional anesthesia.
- A surgical incision is made over the affected tarsal or metatarsal bone.
- The surgeon removes the infected or abnormal area of the bone using specialized instruments.
- The bone and surrounding tissues are carefully debrided to remove any remaining infected material.
- If necessary, bone grafts or other structural supports may be implanted.
- The incision is closed with sutures or staples, and a sterile dressing is applied.
Tools and Equipment:
- Surgical scalpels, bone curettes, and saws
- Anesthesia equipment
- Sterile surgical drapes and instruments
Duration
Typically 1 to 2 hours, depending on the complexity of the case.
Setting
Performed in a hospital or surgical center in an operating room equipped with sterile conditions.
Personnel
- Orthopedic surgeon or podiatric surgeon
- Anesthesiologist or nurse anesthetist
- Surgical nurses and technologists
Risks and Complications
- Infection
- Excessive bleeding
- Damage to surrounding tissues or nerves
- Postoperative pain
- Delayed bone healing or nonunion
- Recurrence of the initial problem
Benefits
- Relief from chronic pain and infection
- Restoration of normal bone function and alignment
- Prevention of further complications or deformities
- Improved quality of life and mobility
Recovery
- Postoperative monitoring in a recovery room
- Pain management with prescribed medications
- Keeping the surgical area clean and dry
- Use of crutches or a walking boot as needed
- Follow-up appointments for wound check and removal of stitches
- Physical therapy to regain strength and flexibility
- Full recovery typically takes several weeks to a few months
Alternatives
- Antibiotic therapy for treating infections without surgery
- Orthotic devices or footwear modifications for managing bone bossing
- Percutaneous drainage or minimally invasive procedures for smaller infections
- Pros: Non-surgical options often have lower risks and shorter recovery times.
- Cons: They may be less effective or appropriate for severe or chronic conditions.
Patient Experience
During the procedure, the patient will be under anesthesia and will not feel any pain. Postoperatively, pain and discomfort can be managed with medications. The patient may experience swelling and limited mobility initially, but these will improve with recovery and rehabilitation efforts.