25035 Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess)

Name of the Procedure:

Incision, deep, bone cortex, forearm and/or wrist (e.g., osteomyelitis or bone abscess)

Summary

This procedure involves making a deep incision into the bone of the forearm or wrist to treat infections such as osteomyelitis or abscesses. By accessing the bone directly, the surgeon can remove infected or dead tissue and help the area heal.

Purpose

The procedure addresses serious bone infections (osteomyelitis) and bone abscesses that are not resolving with medication alone. The primary goals are to eliminate the infection, alleviate pain, and promote healing of the bone.

Indications

• Persistent bone pain and swelling in the forearm or wrist.
• Presence of symptoms and diagnostic evidence of osteomyelitis or bone abscess.
• Failure of antibiotic treatment to clear the infection.
• High white blood cell count or fever indicating infection.

Preparation

• Fasting for at least 8 hours prior to the procedure.
• Adjusting certain medications, including blood thinners, as advised by the physician.
• Pre-procedure imaging tests such as X-rays, MRI, or CT scans to assess the extent of the infection.
• Routine blood tests to evaluate general health and readiness for surgery.

Procedure Description

1. Anesthesia: The patient is given general anesthesia to ensure they are asleep and pain-free during the procedure.
2. Incision: The surgeon makes an incision over the infected area of the forearm or wrist to access the bone.
3. Debridement: The infected or necrotic bone tissue is carefully removed using specialized surgical instruments.
4. Cleaning: The area is thoroughly irrigated to clear out any remaining debris or infectious material.
5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 1 to 2 hours, depending on the extent of the infection and tissue removal required.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Orthopedic surgeon or specialized surgical team.
• Anesthesiologist.
• Surgical nurses and assisting staff.

Risks and Complications

• Infection at the surgical site.
• Bleeding or damage to surrounding tissues.
• Adverse reactions to anesthesia.
• Potential for incomplete removal of the infection, necessitating further treatment.
• Rarely, fractures or bone weakening at the surgical site.

Benefits

• Effective removal of the infection and alleviation of symptoms.
• Improved bone and overall limb health.
• Prevention of the spread of infection to other parts of the body.
• Typically, symptoms begin to improve within a few days to weeks after the procedure.

Recovery

• Hospital stay for monitoring for 1-2 days post-procedure.
• Pain management through prescribed medications.
• Keeping the surgical site clean and dry.
• Follow-up appointments for wound checks and possibly additional imaging.
• Physical therapy may be recommended to restore full function to the forearm or wrist.
• Full recovery can take several weeks to a few months.

Alternatives

• Extended antibiotic therapy, which may be less effective in severe cases.
• Less invasive procedures such as needle aspiration of abscesses, though not always feasible.
• The pros and cons of alternatives generally weigh the effectiveness and invasiveness of the treatment against potential side effects and recovery time.

Patient Experience

• The patient will be asleep and pain-free during the procedure due to general anesthesia.
• Post-operative pain and discomfort at the incision site, manageable with medications.
• Some swelling and limited mobility in the affected limb immediately after surgery.
• Gradual improvement as the site heals, with pain and swelling reducing over time.
• Physical therapy to aid in recovery and restore function to the affected area.