What is Excision of Bone for Osteomyelitis or Bone Abscess: Overview, Benefits, and Expected Results

Definition & Overview

The excision of bone is a medical procedure that can be performed to remove bone abscess or infection. It is a more radical treatment option for persistent osteomyelitis or severe abscess when other treatment methods, such as medications, have failed. Prior to excision, the infection is drained and necrotic tissue is debrided. The procedure is expected to remove the infection or abscess completely, resulting in remission. This means the patient becomes completely cured after the procedure.

Who Should Undergo and Expected Results

The procedure can be recommended for patients who suffer from osteomyelitis. This is a bone infection caused by different types of bacteria, including staphylococcus aureus bacteria, which often affect the femur, distal tibia, proximal tibia, and the fibula. The infection develops when the bacteria settle on a small part of the bone and multiply. Bacteria can reach the bone through the bloodstream or a broken bone that has cut through the skin. The infection may also spread from nearby structures. An ongoing bacterial infection can cause the bone to swell and break if left untreated.

The procedure can also be recommended for patients with bone abscess or a pus-filled pocket that forms within the bones. It usually forms when an active infection is left untreated. Prior to bone excision, the abscess has to be removed. One type of bone abscess, also known as the Brodie’s abscess, is considered as a subacute form of osteomyelitis.

A bone infection or abscess can cause the following symptoms:

• Pain and tenderness over a localised area
• Redness
• General feeling of being unwell
• High fever
• Unexplained weight loss

Patients who are at risk of developing osteomyelitis include those who:

• Have recently suffered a fracture or broken bone
• Have a bone prosthesis in place
• Have had any kind of bone surgery
• Have diabetes or diabetic foot ulcer
• Have a compromised immune system
• Are alcohol dependent
• Have previously experienced osteomyelitis
• Have a blood disorder
• Regularly take steroids
• Require kidney dialysis

Surgical treatment is not the primary option for the management of osteomyelitis or bone abscess. Patients commonly undergo medical therapy first. Unfortunately, doctors are prompted to prescribe surgery if:

• Medical therapy does not work
• The infection is chronic
• The condition involves soft tissue abscess
• There is subperiosteal collection
• There is a concomitant joint infection
• There is neural compression
• There is spinal instability

In general, the surgical excision of bone for osteomyelitis is indicated in stages 3 and 4 of osteomyelitis. This is based on the Cierny-Mader classification system for osteomyelitis.

When performed properly on the right patients, this procedure is likely to completely cure osteomyelitis or bone abscess and prevent recurrence.

How is the Procedure Performed?

Prior to bone excision, the affected area is first prepared by:

• Debriding necrotic tissues
• Removing foreign materials
• Draining the infection
• Making sure surface skin wounds are fully closed
• Making sure any existing fracture in the treatment area has healed

After these preparations, the patient is placed under anaesthesia. The doctor then begins the procedure, which is performed using CT scanning as a visual guide. The procedure is performed through the following steps:

• The surgeon makes the necessary incisions to gain access to the affected part of the bone.
• Focusing on the infection site or the abscess, the surgeon then excises the tumour or the abscess.
• The incision is closed with sutures.
• The surgeon then ensures that there is no dead space (or the soft tissue/bone defect that gets left behind after debridement). The surgeon also ensures that there is adequate soft tissue coverage and that the blood supply to the surgical area is restored.

The management of dead space plays a key role in the long-term success of the procedure. The dead space has to be filled with vascularised tissue, which is usually taken from the ilium or fibula. Managing the dead space properly can help reduce the risk of recurrences and ensure the stability of the bone.

Possible Risks and Complications

Patients who undergo the procedure are at risk of the following:

• Damage to vital nerves and blood vessels
• Recurrence
• Pin-tract infections
• Cellulitis
• Flexion contractures
• Oedema
• Bone fragment rotation with malunion
• Shortening of the affected bone
• Blood poisoning
• Soft tissue atrophy

Recurrence is more likely when there is poor vascularisation in the treated area. This can occur as early as weeks after the procedure or as late as several years after.

References:

• Gupta RC. “Treatment of chronic osteomyelitis by radical excision of bone and secondary skin-grafting.” J Bone Joint Surg Am. 1973 Mar; 55(2): 371-374. http://jbjs.org/content/55/2/371

• Carek PJ, Dickerson LM, Sack JL. “Diagnosis and management of osteomyelitis.” Am Fam Physician. 2001 Jun 15; 63(12): 2413-2421. http://www.aafp.org/afp/2001/0615/p2413.html

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**Excision of‌ Bone for Osteomyelitis or Bone Abscess**



**Overview**



Excision⁣ of bone for osteomyelitis or bone abscess is ⁤a surgical procedure that involves removing infected bone tissue to eliminate the ‍infection. Osteomyelitis​ is a bone infection caused ⁣by ​bacteria or fungi, while a bone abscess is ‍a collection of pus within the bone.



**Procedure**



Excision of bone is typically performed under general anesthesia. The‍ surgical incision depends on the location of ​the infection. ⁢The surgeon removes the infected bone ‌using ⁣a scalpel, drill, or burr. The surrounding healthy bone tissue is preserved to ‍maintain stability.



After the ⁣infected bone is removed, the surgical‍ site is‌ cleaned and debrided to prevent further infection. ⁢Antibiotics are administered to control ⁣the⁤ infection. In some cases,‍ the surgeon‍ may ‌also implant a ⁤metal rod or plate to support the⁣ weakened bone.



**Benefits**



Excision of bone offers several benefits:



* **Infection control:** Eliminates the infected bone tissue, thereby halting⁤ the ​spread of‍ infection and ‌preventing further damage.

* **Pain relief:** Removing the infected bone⁤ relieves pain and discomfort.

* **Improved⁢ mobility:** Restores bone⁤ stability​ and function,​ allowing⁤ for ⁤improved⁢ range of motion and physical activity.

* ⁤**Prevention of osteomyelitis recurrence:** By⁤ removing the infected ​bone, ​the risk of developing osteomyelitis in the same area is significantly reduced.



**Expected Results**



Most patients ​experience successful outcomes after excision‍ of bone. ‌The expected results include:



* **Rapid infection control:** The​ infection⁢ is ⁤brought under​ control within ⁤a few days of surgery.

* **Pain relief and restoration ⁣of function:** Most patients report⁣ significant pain relief and improved ‍mobility after the procedure.

* **Prevention of recurrence:** With ⁢proper post-operative care, the risk of osteomyelitis recurrence‌ is ⁤minimal.



**Recovery**



The recovery period following excision of bone‌ varies depending on the extent of the infection and ‌the surgical approach used.‌ Typically, patients ‍require:



* **Antibiotics:** ⁢Administered​ intravenously or orally to treat the infection.

* **Immobilization:** ⁤The ‍affected bone may be ⁣immobilized using a cast or‍ brace.

* **Wound care:** The⁣ surgical incision‍ is cleaned and ⁢monitored​ for infection.

*‌ **Physical therapy:** Helps restore muscle strength and range of motion.



**Keywords:**



* excision of bone

* osteomyelitis

* ⁢bone abscess

* infection control

* pain relief

* improved mobility

* osteomyelitis recurrence

* prevention ‍of recurrence