Name of the Procedure:

Partial Excision (Craterization, Saucerization, Sequestrectomy, or Diaphysectomy) of the Bone (e.g., Osteomyelitis or Bossing) - Phalanx of Toe

Summary

This surgical procedure involves removing part of the bone in a toe phalanx. It's done to treat conditions like chronic infections (osteomyelitis) or abnormal bone growths.

Purpose

The procedure is aimed at treating infections in the bone (osteomyelitis) or correcting overgrowths and deformities to relieve pain, eliminate sources of infection, and promote better function and mobility.

Indications

• Chronic bone infections (osteomyelitis)
• Bone overgrowth (bossing)
• Recurring bone pain or deformities in the toe
• Failure of previous treatments to resolve bone infection

Preparation

• Fasting is typically required for 8-12 hours before the procedure.
• Adjustment of medications, especially blood thinners, as advised by the surgeon.
• Blood tests, imaging studies (X-ray, MRI), and possibly a bone biopsy to confirm the diagnosis and plan the surgery.

Procedure Description

1. Anesthesia: The patient is given regional or general anesthesia to prevent pain during the operation.
2. Incision: A surgical incision is made over the affected toe.
3. Bone Removal: Specialized surgical tools are used to remove the infected or overgrown portion of the bone. This may involve techniques like craterization (removing a cavity of bone), saucerization (shaping the bone to form a shallow crater), sequestrectomy (removing a sequestrum, or dead bone fragment), or diaphysectomy (removing part of the bone shaft).
4. Closure: The surgical site is thoroughly cleaned to remove debris and is then closed with sutures or staples.
5. Dressing: A sterile bandage is applied.

Duration

The procedure typically takes 1-2 hours, depending on the extent of bone removal required.

Setting

The procedure is usually performed in a hospital or surgical center under sterile conditions.

Personnel

• Orthopedic Surgeon or Podiatric Surgeon
• Anesthesiologist
• Surgical Nurses
• Surgical Technicians

Risks and Complications

• Infection
• Bleeding
• Nerve damage
• Blood clots
• Pain or swelling
• Potential need for further surgery if the infection persists or recurs

Benefits

• Relief from chronic pain
• Elimination of infection
• Improved toe function and mobility
• Prevention of the spread of infection to other areas

Recovery

• Post-operative care includes keeping the foot elevated and applying ice to reduce swelling.
• Pain management with prescribed medications.
• Avoiding weight-bearing activities on the affected foot.
• Follow-up appointments for wound care and monitoring healing.
• Recovery time varies but generally takes several weeks.

Alternatives

• Antibiotic therapy alone (often ineffective for chronic osteomyelitis)
• Amputation of the affected toe (more drastic measure)
• Conservative treatments like drainage procedures (less effective for substantial infection or bone overgrowth)

Patient Experience

• The patient may experience post-operative pain and swelling, managed with medications and ice.
• Discomfort from the surgical incision and restricted movement initially.
• Gradual improvement in mobility and pain as the site heals.
• Emotional support and clear communication with the healthcare team can enhance the recovery experience.