Name of the Procedure:

Incision, Deep, with Opening of Bone Cortex, Femur or Knee (e.g., Osteomyelitis or Bone Abscess)

Summary

This surgical procedure involves making a deep incision to access and open the bone cortex of the femur or knee. It is typically performed to treat infections like osteomyelitis or to drain bone abscesses.

Purpose

This procedure addresses severe bone infections or abscesses that don't respond to antibiotics. By draining abscesses and cleaning the infected area, the goal is to eradicate the infection, relieve pain, and prevent further complications.

Indications

• Persistent or severe bone infection (osteomyelitis)
• Bone abscess in the femur or knee
• Failure of conservative treatments (e.g., antibiotics)
• Symptoms like severe pain, swelling, or fever unresponsive to other treatments

Preparation

• Fasting for at least 8 hours before surgery
• Medication adjustments as advised by the surgeon
• Preoperative diagnostic tests such as blood tests, MRI, or CT scans to assess the extent of the infection

Procedure Description

1. Anesthesia: Administered general or regional anesthesia.
2. Incision: A deep incision is made over the affected area of the femur or knee.
3. Exposure: Soft tissues are carefully retracted to expose the bone cortex.
4. Opening Cortex: A surgical tool called a drill or osteotome is used to open the bone cortex.
5. Drainage and Debridement: Abscesses are drained, and infected bone and tissue are removed.
6. Irrigation: The surgical area is thoroughly irrigated with saline solution to flush out debris.
7. Closure: Sutures or staples are used to close the incision.

Duration

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

Setting

The procedure is performed in a hospital operating room.

Personnel

• Orthopedic Surgeon
• Surgical Nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Damage to surrounding tissues
• Anesthesia-related complications
• Recurrence of infection

Benefits

• Effective treatment of chronic bone infections
• Pain relief
• Prevention of further complications such as bone loss or spread of infection

Recovery

• Hospital stay for a few days for monitoring and intravenous antibiotics
• Pain management with prescribed medications
• Wound care instructions and follow-up appointments
• Physical therapy may be recommended to improve mobility and strength
• Full recovery can take several weeks to months

Alternatives

• Long-term antibiotic therapy (may be insufficient alone for severe infections)
• Less invasive drainage procedures (may not be effective for deep or extensive infections)
• Amputation (considered only in extreme, life-threatening cases)

Patient Experience

Patients often experience relief from severe pain after the infection is addressed. Discomfort from the surgery itself is managed with pain medications. Postoperative care includes regular follow-up visits to monitor healing and ensure the infection has resolved.