Name of the Procedure:

Partial excision (craterization, saucerization, or diaphysectomy) of bone, femur, proximal tibia, and/or fibula (e.g., osteomyelitis or bone abscess).

Summary

This surgical procedure involves removing a localized part of an infected or diseased bone, often due to conditions like osteomyelitis or a bone abscess. This can include techniques such as craterization, saucerization, or diaphysectomy to clear out the affected area and promote healing.

Purpose

The purpose of this procedure is to eliminate infection or disease within the bone, mainly due to chronic or severe osteomyelitis or bone abscesses. The goal is to remove the infected tissue to prevent the spread of infection, relieve pain, and facilitate healing, thereby improving the patient’s mobility and overall health.

Indications

• Persistent or severe osteomyelitis.
• Bone abscess that has not responded to other treatments.
• Chronic pain or discomfort in the affected bone.
• Signs of systemic infection (e.g., fever) alongside localized bone symptoms.
• Imaging studies showing a significant area of infected or damaged bone.

Preparation

• Fasting for a specified period before the procedure.
• Adjustment or temporary discontinuation of certain medications, as advised by the doctor.
• Preoperative blood tests, imaging studies (like X-rays, MRI, or CT scans), and sometimes a bone biopsy.
• Antibiotics may be administered before surgery to reduce infection risk.

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incision: A surgical incision is made over the affected area.
3. Exposure: The underlying bone is exposed by retracting the soft tissues.
4. Removal: Using specialized tools, the surgeon removes the infected or necrotic bone tissue through one of the techniques:
   • Craterization: Creating a shallow crater by excising the diseased area.
   • Saucerization: Carving out a broader, saucer-shaped section.
   • Diaphysectomy: Removing a segment of the bone shaft.
5. Irrigation: The area is thoroughly irrigated to remove any debris.
6. Closure: The incision is closed using 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 disease and complexity.

Setting

This procedure is performed in a hospital or surgical center equipped for orthopedic surgery.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding tissues or nerves
• Blood clots
• Non-healing or delayed healing of the bone
• Recurrent infection
• Adverse reactions to anesthesia

Benefits

• Relief from pain and discomfort caused by bone infection.
• Removal of diseased tissue to prevent the spread of infection.
• Enhanced mobility and improved quality of life.
• Reduction in the need for repeat surgeries or long-term antibiotic therapies.

Recovery

• Initial hospital stay of a few days to monitor healing and manage pain.
• Instructions for wound care and any prescribed antibiotics.
• Physical therapy may be recommended to restore function and strength.
• Follow-up appointments to monitor bone healing and overall progress.
• Full recovery can range from several weeks to a few months, depending on the extent of surgery and patient health.

Alternatives

• Long-term antibiotic therapy alone (may not be as effective for severe cases).
• Hyperbaric oxygen therapy in conjunction with antibiotics.
• Amputation in extreme cases where infection is beyond control.
• Each alternative has its pros and cons, such as a longer treatment duration or the potential for incomplete resolution of infection.

Patient Experience

Patients may experience some pain and discomfort following the surgery, which is managed with medications. There may be restrictions on weight-bearing activities initially, and physical therapy plays a crucial role in full recovery. Patients should follow all post-operative care instructions to aid in healing and prevent complications.