27640 Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibia

Name of the Procedure:

Partial Excision (Craterization, Saucerization, or Diaphysectomy) of the Bone (e.g., Osteomyelitis) - Tibia

Summary

In this procedure, a surgeon removes a portion of the tibia affected by an infection or disease, such as osteomyelitis. Techniques may include creating a crater, saucer-like shape, or diaphysectomy to excise diseased bone and promote healing.

Purpose

This procedure aims to remove infected or necrotic bone tissue from the tibia, typically caused by osteomyelitis. The goal is to eradicate the infection and allow the remaining healthy bone to heal, preventing further spread of the infection and restoring normal function.

Indications

• Persistent infection in the tibia, such as osteomyelitis, unresponsive to antibiotics.
• Symptoms like severe pain, swelling, warmth, or redness over the affected bone.
• Presence of abscesses, sinus tracts, or sequestra (dead bone tissue).

Preparation

• Fasting for 6-8 hours before the procedure.
• Adjustments or discontinuation of certain medications (e.g., blood thinners).
• Pre-operative imaging studies (X-ray, MRI, CT scans) and lab tests (blood tests to assess infection markers).

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free.
2. An incision is made over the affected area of the tibia.
3. The surgeon may use tools such as scalpels, curettes, and drills to excise the infected or necrotic bone tissue.
4. Techniques can include craterization (creating a crater-like removal), saucerization (removing a saucer-shaped portion), or diaphysectomy (removing a segment of the bone’s diaphysis).
5. The area is thoroughly cleaned to remove any residual infection.
6. If needed, bone grafting materials may be used to fill the void.
7. The incision is closed with sutures or staples, and a sterile dressing is applied.

Duration

The procedure typically takes 1-2 hours, depending on the extent of the infection and amount of bone to be removed.

Setting

This procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses and technicians
• Anesthesiologist

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Damage to surrounding nerves or blood vessels
• Delayed bone healing or non-healing
• Recurrence of the infection

Benefits

Removal of infected or necrotic bone, leading to resolution of infection. Reduction in pain and improvement in limb function. Prevention of further spread of infection and potential complications from untreated osteomyelitis.

Recovery

• Hospital stay for 1-2 days for monitoring and initial recovery.
• Pain management with prescribed medications.
• Restricted weight-bearing or use of crutches/walker for several weeks.
• Follow-up appointments for wound check and possibly additional imaging.
• Physical therapy may be recommended to restore mobility and strength.

Alternatives

• Long-term antibiotic therapy alone, which may be less effective for chronic or severe infections.
• Hyperbaric oxygen therapy to enhance infection resolution.
• Amputation in severe or refractory cases, albeit with significant loss of limb function.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Afterward, there may be discomfort and pain managed with medication. Swelling and limited mobility in the leg are expected. Pain and swelling should gradually improve over days to weeks. Instructions for wound care, medication adherence, and physiotherapy will be provided to support the recovery process.