Cranial Osteomyelitis Surgery

At the beginning of skull osteomyelitis, inflammation can be limited to the barrier, local manifestations of redness and heat pain, systemic fever, and increased white blood cells. If the inflammation is not controlled in time, the infection continues to spread, and subperiosteal, epidural, subdural, or brain abscesses can form. If the treatment is not complete and prolonged to the chronic phase, repeated wound infections can be formed, sinus formation, long-term unhealed, and even dead bone fragments. In the acute phase, it should be treated with a large enough dose of antibiotics. If an abscess has formed, the drainage should be incision. After the infection is limited, surgery should be performed to completely remove dead bone, granulation tissue and sinus necrotic tissue. Treatment of diseases: skull osteomyelitis Indication 1. Skull osteomyelitis has formed a scalp or subperiosteal abscess. 2. Chronic skull osteomyelitis, multiple drainage, debridement and unhealing, suggesting that the lesion bone or epidural abscess or granulation tissue is not thoroughly cleaned, and thorough surgery should be performed. 3. Nasal, otogenic and hematogenous osteomyelitis, in addition to the removal of diseased bone surgery, the primary infection should also be treated. 4. After craniotomy, local infection causes skull necrosis, and the necrotic bone flap should be removed. 5. Open fractured skull fracture caused by skull osteomyelitis, confirmed by X-ray of the skull, should pay attention to remove all kinds of foreign bodies during the operation. Preoperative preparation 1. Learn more about the presence or absence of infection to the intracranial expansion. 2. Sinus bacterial culture and antibiotic drug sensitivity test should be performed before operation. Effective antibiotics should be applied 3 days before surgery. Injury cranial osteomyelitis should be injected with tetanus anti-toxic serum before surgery. Surgical procedure Incision The scalp incision should be designed according to the different parts of the lesion and the size of the lesion. The general principle is that it is required to fully expose the infected skull and ensure the blood supply to the scalp. At the end of the suture, the skin should not be too tight to avoid necrosis. At the same time, you should also pay attention to beauty. Generally, an "S" shaped incision or a horseshoe shaped incision is used. 10.2 2. Reveal the diseased skull In the direction of the incision line, the epidermis was cut, the skin sinus was removed from the wound margin by 0.2 cm, and the wound culture was carried out in parallel to fully reveal the diseased skull. 10.3 3. Treatment of lesion skull It must be completely removed to fully expose the normal skull around the diseased skull and the normal dura mater, to fully remove necrotic tissue, granulation tissue, dead bone, subperiosteal empyema, empyema in the stenosis and surrounding ivory-like bone. The method of removing the diseased skull is to drill the skull in the osteomyelitis area of the diseased skull, and use the rongeur to bite the diseased bone, or drill a hole adjacent to the normal skull, bite off a circle of bone and remove the diseased skull. 4. Clear dura mater granulation tissue After removing the diseased skull, the foreign body, dead bone and granulation tissue should be removed at the same time. The granulation tissue on the dura mater is gently and carefully scraped with a curette. If the tissue is thick, the scar tissue can be carefully removed with a blade, but the dura mater is not cut, and once it is found to be cut, it is sewn. After the infection is removed, the disinfection towel should be replaced, the instrument should be cleaned, and the bone is removed from the bone to the exposed dura mater 1cm. The bone wax is coated with penicillin and streptomycin powder to stop bleeding, and repeated 500ml of normal saline. The wound is dissolved in 80,000 to 160,000 U of gentamicin solution, and the bacteria are routinely cultured. 5. Wound treatment After debridement and hemostasis, the wound was further filled with 200,000 U of penicillin and 0.3-0.5 g of streptomycin. Conventional rubber hollow drainage was performed, and the incision was sutured in the whole layer. If there is an acute infection, the incision may be partially sutured or the incision may be opened, and the iodoform gauze or the antibiotic gauze may be padded to wrap the wound. complication 1. Systemic or local infection. 2. Due to incomplete hemostasis or poor drainage during debridement, it may cause hemorrhage under the scalp and form a hematoma, which may lead to postoperative local infection and should be promptly examined and treated. 3. Debridement is not complete, easy to leave inflammatory granulation tissue, dead bones and foreign bodies, can lead to recurrence of inflammation and abscess formation, should be promptly examined and treated. 4. After the postoperative temperature rise, wound fluid, and headache and other symptoms of systemic poisoning, consider the possibility of intracranial inflammation, should be timely lumbar wear, to confirm the diagnosis, active treatment, concurrent systemic medication and intrathecal Dosing. 5. If there is cerebrospinal fluid leakage, surgery should be repaired in time.