dishing

Dish is to turn the dead cavity like a pot or bottle into a shallow dish with a large bottom to facilitate the drainage and the surrounding soft tissue to collapse and eliminate the dead space. However, in the dead space near the joint or the main weight-bearing bones of the lower limbs, it is not appropriate to perform a large disc to avoid damage to the joint cavity, the spread of infection and the sturdiness of the bone. Treatment of diseases: chronic osteomyelitis in children with chronic osteomyelitis Indication 1. Chronic osteomyelitis after removal of the dead bone, the residual dead space is large and deep, but the mouth is small, it is estimated that the drainage is not smooth. 2. Location of shallow bones, such as humerus, ulna, humerus and other chronic osteomyelitis, lack of soft tissue surrounding, skin scars are larger. 3. Osteoporosis around the bone cavity, poor blood supply. Preoperative preparation 1. Apply antibiotics for 1 to 2 weeks before surgery to control infection. It is best to do a pus bacterial culture and antibiotic susceptibility test first. The general condition should be improved. Local acute inflammation should cause it to completely resolve. 2. If the scope of surgery is large, a certain amount of blood should be prepared for intraoperative application. 3. Conventional preoperative examination of the bone and lateral x-ray films to examine the condition of dead bone, dead space and new bone to correctly determine the timing and exposure of the operation. If necessary, the secondary layer should be taken or the sinus angiography should be used as a reference. 4. Preoperative skin preparation must be prepared to reduce the chance of secondary infection and cannot be ignored because it is infected with the wound. 5. If a pathological fracture is combined, it must be treated until the fracture is basically healed. It is estimated that it can be operated when there is enough osteophyte support after removing the dead bone. Surgical procedure 1. The incision, the exposure of the lesion, and the removal of the dead bone are the same as the removal of the dead bone. Surgery should be performed under the tourniquet. 2. Open the dead space and design the bone to be removed according to the size of the dead space. Then, the bone is cut off along the edge of the dead space with an osteotome until it becomes a shallow dish. In order to prevent the fracture caused by chiseling, it can be drilled around the bone to be cut [Fig. 1 (1)] and then the chisel bone should be drilled along the hole to reach the bleeding of the bone wall. However, care should be taken not to remove too much normal bone to avoid pathological fractures that affect the firmness of the bone. 3. Wound treatment, such as the repair of the disc shape is satisfactory, the surrounding soft tissue collapse can eliminate the dead space, can be used for one-stage suture, local pressure bandage, and promote soft tissue close to the cavity wall. If there is no soft tissue around, you need to fill the bone cavity with Vaseline gauze [Fig. 1 (2)], and then cover with a sterile dressing. The upper tube gypsum seals the ward and external fixation.