Name of the Procedure:

Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of finger

Summary

This procedure involves the surgical removal of part of the bone in the finger, specifically the proximal or middle phalanx. It is commonly performed to treat bone infections like osteomyelitis or other disorders affecting the bone.

Purpose

The procedure aims to remove infected or diseased bone tissue to prevent the spread of infection, promote healing, and alleviate pain. The expected outcome is the resolution of the infection and preservation of finger function.

Indications

• Chronic or acute osteomyelitis (bone infection) in the finger
• Bone abscesses or cysts
• Non-healing fractures or bone defects
• Severe bone pain or inflammation unresponsive to non-surgical treatments

Preparation

• Patients may need to fast for a specific period before the procedure.
• Discussions with the doctor about any current medications and potential adjustments.
• Pre-surgical diagnostic tests, such as X-rays, MRI, or blood tests, to assess the extent of bone involvement.

Procedure Description

1. The procedure starts with administrating anesthesia, typically regional or general, depending on the case.
2. An incision is made to access the proximal or middle phalanx of the affected finger.
3. The surgeon uses specialized instruments to carefully remove the infected or diseased portion of the bone.
4. The area may be smoothed out or reshaped (craterization or saucerization) to facilitate healing.
5. The wound is irrigated to ensure all infected tissue is removed.
6. The incision is then closed with sutures, and a sterile dressing is applied.

Duration

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

Setting

This procedure is generally performed in a hospital or surgical center equipped with the necessary facilities for bone surgery.

Personnel

• Orthopedic surgeon or specialized hand surgeon
• Anesthesiologist
• Surgical nurse
• Operating room technician

Risks and Complications

• Infection at the surgical site
• Nerve damage leading to numbness or reduced mobility
• Prolonged pain or swelling
• Delayed bone healing or non-union
• Need for additional surgeries if the infection persists

Benefits

• Removal of the infected bone tissue
• Alleviation of pain and discomfort
• Prevention of the spread of infection to other parts of the body
• Improvement in finger function and mobility

Recovery

• Post-procedure care includes keeping the finger elevated and protected.
• Pain management with prescribed medications.
• Wound care instructions to prevent infection.
• Follow-up appointments for assessment and removal of stitches.
• Avoiding heavy lifting and strenuous activities with the affected hand for several weeks.
• Physical therapy may be recommended to restore movement and strength.

Alternatives

• Antibiotic therapy as a non-surgical approach, though less effective for chronic cases.
• Amputation in severe cases where bone and tissue are extensively damaged.
• Debridement (removal of damaged tissue) without bone excision.

Patient Experience

• Patients may feel discomfort and pain post-procedure, managed with painkillers.
• Initial swelling and bruising are common.
• Recovery involves limited use of the affected hand, with gradual improvement in pain and function.
• Consistent follow-up and adherence to post-operative care are crucial for optimal recovery.