Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck
CPT4 code
Name of the Procedure:
Sequestrectomy (e.g., for osteomyelitis or bone abscess), radial head or neck
Summary
A sequestrectomy is a surgical procedure performed to remove a piece of dead bone, known as a sequestrum, typically resulting from infections such as osteomyelitis or bone abscesses, especially in the radial head or neck.
Purpose
The purpose of a sequestrectomy is to treat infections in the bone, like osteomyelitis or bone abscesses, by removing the dead bone tissue. This helps to alleviate pain, prevent the spread of infection, and promote healing of the affected bone.
Indications
- Persistent infection in the bone (osteomyelitis)
- Presence of a bone abscess
- Chronic pain and swelling not responding to antibiotic therapy
- Evidence of a sequestrum (dead bone) on imaging studies
- Failure of previous non-surgical treatments
Preparation
- Patients may be required to fast for several hours before the procedure.
- Adjustments to current medications, especially blood thinners, may be needed.
- Pre-operative imaging tests like X-rays or MRIs to locate the sequestrum.
- Blood tests to assess overall health and infection levels.
Procedure Description
- The patient is given anesthesia, usually general, to ensurecomfort.
- An incision is made over the affected area of the radial head or neck.
- The bone and surrounding tissues are carefully exposed.
- The sequestrum (dead bone) is identified and removed.
- The area is thoroughly cleaned to remove any residual infection.
- The incision is closed with sutures or staples.
- A sterile dressing is applied to protect the site.
Duration
The procedure typically takes about 1-2 hours, depending on the extent of the infection and the complexity of the case.
Setting
The procedure is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Orthopedic surgeon
- Surgical nurse
- Anesthesiologist
- Scrub technician
Risks and Complications
- Infection
- Bleeding or hematoma
- Damage to surrounding nerves or blood vessels
- Recurrence of osteomyelitis
- Delayed bone healing or nonunion
Benefits
- Removal of infected bone tissue, promoting healing
- Relief from pain and swelling
- Prevention of infection spread
- Improved function and mobility of the affected limb Benefits may be noticed shortly after recovery from surgery and are generally long-lasting if the infection is controlled.
Recovery
- Patients may need to stay in the hospital for a few days for monitoring.
- Pain management with medications as prescribed.
- Keep the surgical site clean and dry; follow specific wound care instructions.
- Gradual return to activities as advised by the surgeon.
- Follow-up appointments to monitor healing and check for infection recurrence.
- Physical therapy may be recommended to restore mobility and strength.
Alternatives
- Prolonged antibiotic therapy
- Hyperbaric oxygen therapy
- Debridement (cleaning out the infected tissue without removal of bone)
- Pros: Less invasive
- Cons: May not be as effective in removing severe infections
Patient Experience
During the procedure, patients will be under anesthesia and will not feel pain. Afterward, they may experience some pain, swelling, and discomfort which can be managed with medications. Mobilization can be gradual, and adherence to post-operative care instructions is crucial for effective recovery.