Name of the Procedure:

Incision (eg, osteomyelitis or bone abscess), leg or ankle

Summary

In this procedure, a healthcare professional makes an incision in the leg or ankle to drain pus and remove infected or dead bone tissue. This treatment is typically required for conditions like osteomyelitis (bone infection) or a bone abscess.

Purpose

The procedure addresses severe infections in the bone, most commonly osteomyelitis or bone abscesses. The main goals are to remove the infection, alleviate pain, and prevent the spread of the infection, thus aiding in the healing process.

Indications

• Persistent, severe pain in the leg or ankle
• Fevers and chills associated with bone infection
• Redness, swelling, and warmth over the affected bone or joint
• Non-healing wounds or ulcers near the affected area
• Laboratory evidence of bone infection (elevated white blood cell count, inflammatory markers)

Preparation

• Fasting for 6-8 hours before the procedure, especially if general anesthesia is used
• Adjustments or temporary discontinuation of certain medications (e.g., blood thinners)
• Pre-operative imaging tests like X-rays, MRI, or CT scans to locate the infection
• Blood tests to check overall health and infection levels

Procedure Description

1. The patient is positioned on an operating table, and the affected leg or ankle is cleaned and sterilized.
2. Anesthesia is administered—either local, regional, or general, depending on the case specifics.
3. The surgeon makes an incision over the affected area.
4. Infected pus and any dead bone tissue are removed using surgical instruments.
5. The area is thoroughly cleaned with a sterile solution.
6. Drains may be placed to prevent fluid buildup.
7. The incision is closed with sutures or staples and covered with a sterile dressing.
8. Antibiotics are administered to help combat the infection.

Duration

The procedure usually takes about 1-2 hours, depending on the extent of the infection and the complexity of the case.

Setting

The procedure is typically performed in a hospital's operating room, though it may also be done in an outpatient surgical center under appropriate conditions.

Personnel

• Orthopedic surgeon or general surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection at the surgical site
• Excessive bleeding
• Damage to nearby nerves or blood vessels
• Incomplete removal of the infection
• Recurrence of the infection
• Adverse reactions to anesthesia

Benefits

• Relief from pain and other symptoms caused by the infection
• Reduced risk of the infection spreading
• Improved function and mobility in the affected limb
• Healing of the infected bone and surrounding tissues

Recovery

• Pain management with prescribed medications
• Keeping the surgical site clean and dry to prevent infection
• Wearing a brace or splint if needed to immobilize the affected area
• Physical therapy to regain strength and mobility
• Follow-up appointments to monitor healing
• Recovery time varies but generally spans from a few weeks to several months

Alternatives

• Antibiotic therapy alone (often insufficient for severe infections)
• Needle aspiration to drain abscess (less invasive but may not be effective for deep infections)
• Hyperbaric oxygen therapy (adjunct therapy to promote healing)

Patient Experience

During the procedure, if under local anesthesia, patients may feel pressure but should not feel pain. Post-procedure, there may be discomfort or pain, managed with pain relief medications. Swelling and bruising around the incision site are common, and patients should follow care instructions diligently to promote healing and avoid infection.