Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), scapula
CPT4 code
Name of the Procedure:
Partial Excision (Craterization, Saucerization, or Diaphysectomy) of Bone (e.g., Osteomyelitis), Scapula
Summary
Partial excision of the scapula involves the surgical removal of an infected or damaged portion of the scapula (shoulder blade) usually due to conditions like osteomyelitis. Techniques such as craterization, saucerization, or diaphysectomy are used to excise affected bone tissue while preserving as much healthy bone as possible.
Purpose
This procedure addresses severe infections, such as osteomyelitis, or other bone conditions affecting the scapula. The primary goal is to remove the damaged or infected bone tissue to prevent the spread of infection and promote healing while maintaining as much function and structure of the scapula as possible.
Indications
- Chronic osteomyelitis (bone infection) in the scapula
- Non-responsive to antibiotic therapy
- Chronic pain or functional impairment due to bone infection
- Presence of a bone abscess or sequestrum (dead bone)
Preparation
- Fasting for at least 8 hours prior to surgery
- Adjustment or discontinuation of certain medications as advised by the physician
- Diagnostic tests such as X-rays, MRI, or CT scans to determine the extent of the infection
- Blood tests to assess overall health and suitability for surgery
Procedure Description
- The patient is administered general anesthesia to ensure they are asleep and pain-free during the procedure.
- The surgeon makes an incision over the scapula to expose the affected bone.
- Using specialized tools, the surgeon performs craterization, saucerization, or diaphysectomy to remove the infected or damaged bone tissue.
- The surgical area is thoroughly cleaned to eliminate any remaining infection.
- The incision is closed with sutures or staples, and a sterile dressing is applied.
Duration
The procedure typically takes between 1 to 3 hours, depending on the extent of the bone removal required.
Setting
The procedure is performed in a hospital operating room or a surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurses
- Anesthesiologist
- Surgical technician
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma
- Damage to surrounding tissues or structures
- Persistent pain or impaired shoulder function
- Anesthetic complications
- Scar formation
Benefits
- Alleviation of infection and associated symptoms
- Prevention of further spread of infection
- Improvement in shoulder function and reduction in pain
- Potential to avoid more extensive surgery or bone damage
Recovery
- Hospital stay of 1 to 3 days post-procedure
- Pain management with prescribed medications
- Physical therapy to restore shoulder function and strength
- Dressings and wound care instructions
- Activity restrictions, such as avoiding heavy lifting, for several weeks
- Follow-up appointments to monitor healing and detect any complications
Alternatives
- Long-term antibiotic therapy (less effective for chronic osteomyelitis)
- Needle aspiration or drainage of abscesses (less invasive but may not fully resolve infection)
- Complete scapula resection (more extensive surgery with greater functional impact)
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Post-procedure, they may experience pain and discomfort managed by medications. Swelling, bruising, and limited shoulder movement are expected initially, but these symptoms improve with time and rehabilitation.
Pain management strategies, physical therapy, and proper care facilitate recovery and enhance overall comfort during the healing process.