23035 Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area

Name of the Procedure:

Incision, bone cortex (e.g., osteomyelitis or bone abscess), shoulder area

Summary

This procedure involves making an incision into the bone cortex of the shoulder area to treat conditions like osteomyelitis (bone infection) or a bone abscess (a pocket of pus within the bone). It allows for drainage, removal of infected tissue, and alleviation of pressure caused by infection or abscess.

Purpose

The primary goal of this procedure is to treat infections or abscesses in the bone of the shoulder area. It helps to eliminate the source of infection, relieve pain, and prevent further complications such as the spread of infection or bone damage.

Indications

• Persistent pain or swelling in the shoulder area
• Confirmed diagnosis of osteomyelitis or bone abscess via imaging or laboratory tests
• Failure of conservative treatments like antibiotics to resolve the infection
• Evidence of abscess formation causing pressure and damage

Preparation

• Fasting may be required for a certain period before the procedure, typically 6-8 hours.
• Patients might need to adjust or stop certain medications, especially blood thinners.
• Pre-procedure diagnostic tests, such as blood tests and imaging studies (e.g., MRI or CT scan), will be conducted to assess the extent of the infection or abscess.

Procedure Description

1. Anesthesia is administered; this can be either general anesthesia (the patient is asleep) or regional anesthesia (the patient is numbed from the shoulder down).
2. The surgical site is cleaned and sterilized.
3. A precise incision is made in the skin and soft tissues over the affected area of the shoulder.
4. The surgeon carefully cuts through the layers until reaching the bone cortex.
5. The infected or necrotic bone tissue is debrided (removed) and any abscess is drained.
6. The site is thoroughly irrigated with a sterile solution.
7. If necessary, the surgeon may place a drain to continue removing fluids post-surgery.
8. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity and extent of the infection.

Setting

This procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technician

Risks and Complications

• Infection at the incision site
• Bleeding or hematoma formation
• Damage to surrounding tissues or structures (nerves, blood vessels)
• Residual infection requiring further treatment
• Anesthesia-related complications
• Prolonged healing or poor bone healing

Benefits

• Relief from pain and swelling
• Elimination of infection, reducing the risk of it spreading
• Improved shoulder function and mobility
• Prevention of further bone damage or systemic complications

Recovery

• Post-procedure care includes managing pain with prescribed medications, keeping the incision site clean and dry, and attending follow-up appointments for wound checks and removal of sutures or staples.
• Physical therapy may be recommended to restore shoulder function.
• Recovery time varies but generally ranges from several weeks to a few months, during which heavy lifting and strenuous activities should be avoided.

Alternatives

• Long-term antibiotic therapy without surgery, though this may not be effective for abscesses or severe infections.
• Percutaneous drainage, which is less invasive but might not be suitable for all cases.
• Hyperbaric oxygen therapy, used in conjunction with other treatments for osteomyelitis.

Patient Experience

During the procedure, patients will be under anesthesia and should not feel pain. Post-procedure, there may be discomfort and swelling in the shoulder area, managed with pain medications. Patients might feel tired or weak initially and will experience gradual improvement over the following weeks with adherence to post-operative care instructions.