28005 Incision, bone cortex (eg, osteomyelitis or bone abscess), foot

Name of the Procedure:

Incision of the bone cortex (e.g., osteomyelitis or bone abscess), foot

Summary

This surgical procedure involves making an incision into the outer layer of the bone (cortex) in the foot to treat infections such as osteomyelitis or bone abscess. It aims to remove infected material and improve healing.

Purpose

• Medical Conditions: Osteomyelitis, bone abscess.
• Goals: To remove infected tissue, alleviate pain and inflammation, and promote healing of the bone to prevent further infection.

Indications

• Symptoms: Severe pain in the foot, swelling, redness, warmth, fever, or drainage from the wound.
• Conditions: Chronic or acute osteomyelitis, bone abscess that does not respond to antibiotic therapy alone.
• Criteria: Persistent infection despite medication, failure of conservative treatments.

Preparation

• Pre-Procedure Instructions: Fasting 6-8 hours before surgery, stop certain medications as advised by your doctor.
• Diagnostic Tests: Blood tests, imaging studies like X-ray, MRI, or CT scans to ascertain the extent of infection.

Procedure Description

1. Anesthesia: Administered general or regional anesthesia for numbness and comfort.
2. Initial Incision: A precise surgical cut made over the affected area of the foot.
3. Bone Cortex Incision: Special surgical instruments are used to cut through the cortical layer of the bone.
4. Removal of Infected Material: Drainage and debridement of the infected tissues or abscess.
5. Closure: Incision is cleaned and closed, often with sutures, and sometimes with the placement of a drain.

• Tools: Scalpels, retractors, bone saws or chisels, suction devices.
• Anesthesia: General or regional anesthesia to prevent pain during the procedure.

Duration

The procedure typically lasts 1-2 hours.

Setting

Performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon: Typically an orthopedic surgeon.
• Anesthesiologist or nurse anesthetist: To administer and monitor anesthesia.
• Surgical nurse: To assist the surgeon.

Risks and Complications

• Common Risks: Pain, swelling, infection, or bleeding at the surgical site.
• Rare Complications: Nerve damage, incomplete removal of infected tissue leading to persistent infection, blood clots.
• Management: Antibiotics, pain management, and close monitoring.

Benefits

• Expected Benefits: Relief from pain, reduction in infection, improved foot function.
• Timing: Benefits typically noticeable within a few weeks as infection subsides and healing progresses.

Recovery

• Post-Procedure Care: Wound care instructions, medications for pain and infection control.
• Recovery Time: Several weeks to a few months, depending on the severity of the infection and patient health.
• Restrictions: Limited weight-bearing activities, use of crutches or mobility aids as advised.
• Follow-Up: Regular appointments to monitor healing and prevent complications.

Alternatives

• Non-Surgical: Prolonged antibiotic therapy, hyperbaric oxygen therapy.
• Surgical Alternatives: Larger debridement procedures, partial foot amputation in severe cases.
• Pros and Cons: Non-surgical methods may not be sufficient for severe infections; surgical alternatives may be more invasive than the cortex incision.

Patient Experience

• During Procedure: Under anesthesia, so the patient will not feel pain during the surgery.
• After Procedure: Mild to moderate pain managed with medications, possible swelling, and the need for rest and limited movement.
• Pain Management: Pain relievers and antibiotics are typically prescribed. Comfort measures include elevation, ice application, and avoiding pressure on the foot.