Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle
CPT4 code
Name of the Procedure:
Sequestrectomy of the Clavicle (Removal of Dead Bone Tissue from the Collarbone)
Summary
A sequestrectomy is a surgical procedure where a portion of dead or infected bone is removed from the clavicle (collarbone). This is commonly performed to treat severe bone infections, known as osteomyelitis, or bone abscesses.
Purpose
The primary purpose of a sequestrectomy is to eliminate the source of infection and dead bone tissue to promote healing and prevent the spread of infection. The procedure aims to relieve pain, restore function, and improve the patient's quality of life.
Indications
- Persistent or severe osteomyelitis of the clavicle
- Presence of a bone abscess in the collarbone area
- Non-responsive to antibiotic therapy
- Chronic pain or functional impairment due to dead bone tissue
Preparation
- Patients may be required to fast for several hours before the procedure.
- Preoperative blood tests, imaging studies (such as X-rays or MRI), and a thorough medical evaluation.
- Adjustments to current medications, especially anticoagulants or blood thinners.
Procedure Description
- The patient is typically placed under general anesthesia.
- An incision is made over the affected area of the clavicle.
- The surgeon uses specialized tools to remove the dead or infected bone tissue (sequestrum).
- Any remaining healthy bone is cleaned and debrided to ensure all infected tissue is removed.
- The incision is closed with sutures, and a sterile dressing is applied.
Duration
The procedure typically takes between 1 to 2 hours, depending on the extent of the infection and the complexity of the case.
Setting
Sequestrectomy is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon or general surgeon
- Anesthesiologist
- Surgical nurses and technicians
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Damage to surrounding nerves or blood vessels
- Delayed bone healing or nonunion
- Recurrence of the infection
Benefits
- Elimination of infection
- Relief from pain and discomfort
- Improved function and mobility of the affected arm and shoulder
- Prevention of further complications from osteomyelitis
Recovery
- Pain management with prescribed medications
- Keeping the surgical site clean and dry
- Physical therapy to restore strength and function to the arm and shoulder
- Limiting strenuous activities and following activity restrictions as advised by the surgeon
- Follow-up appointments for monitoring and assessment of healing
Alternatives
- Long-term antibiotic therapy alone, although this may not be sufficient for severe cases
- Debridement without sequestrectomy, which may not completely remove dead bone tissue
- Amputation in extreme and rare cases if the infection is uncontrollable
Patient Experience
- Patients will be under anesthesia during the procedure and will not feel pain.
- Postoperative discomfort can be managed with pain medications.
- It is common to experience some soreness and limited use of the arm for several weeks.
- Patients usually need to follow a rehabilitation program to regain full function.