tuberculosis debridement

Chest wall tuberculosis is part of systemic tuberculosis, and attention should be paid to systemic treatment and rest, nutrition, and anti-tuberculosis medication. If there is active tuberculosis, mediastinum or hilar lymphatic tuberculosis, chest tuberculosis should be performed after the condition is stable. When the abscess has a mixed infection and the local skin is red and thin, the pus can be punctured from the healthy skin, and the antibiotics can be applied locally or systemically, or the drainage can be performed first. After the body has no obvious poisoning reaction and the local acute inflammation subsides, the lesion is removed. Treatment of diseases: chest wall tuberculosis Indication Thoracic tuberculosis abscess or chronic sinus, as long as the condition is relatively stable, lung and other organs without active tuberculosis, should be completely removed. Contraindications The condition is still unstable, and there are active tuberculosis lesions in other areas, and no surgery is available. Preoperative preparation 1. Improve the general nutritional status of the body. 2. According to the patient's condition, preoperative anti-tuberculosis treatment for 2 to 4 weeks. Surgical procedure Incision If the skin and superficial muscles are not invaded by the lesion, they are cut along the long axis of the abscess. If the skin has been affected or has a pupil present, a fusiform incision should be made according to the long axis of the lesion to remove the diseased skin and sinus ostium. 2. Clear superficial abscess After the skin is cut, release the skin and muscle layer to both sides. Try not to cut into the abscess. If the abscess is broken, remove the pus and cheese. 3. Explore sinus and deep abscess Probes or curved vascular clamps are used to find the sinus and the abscess below the ribs. The sinus is not necessarily straight, sometimes thin, and must be carefully searched for. 4. Clear the sinus and deep abscess Excision of the sinus and covering the tissue above the deep abscess, including the ribs, intercostal muscles, etc., so that the abscess is completely open, and the granulation tissue and the wall of the abscess are completely removed; the wall of the abscess can be completely scraped off with a curette. 5. Free muscle flap The cleared abscess was rinsed with 5% sodium bicarbonate solution and normal saline, and the nearby muscle flap was freed, filled in the abscess, and fixed with an absorbable thread. 6. Suture incision A rubber drainage strip was placed between the muscle layers, streptomycin powder was placed under the muscle flap, the subcutaneous tissue and skin were sutured, and the dressing was performed under pressure. complication 1. The wound failed to heal in the first stage Often due to insufficient filling of the muscle flap, there is still a residual cavity, or the retention of the effusion is not eliminated in time, or the postoperative pressure bandage is improper. 2. Recurrence of the lesion Mainly because the lesions have not been completely removed, there are still residual lesions. Sometimes the sinus is too thin to find residual lesions or wrapped tuberculous empyema, and the chest wall tuberculosis lesions are not in the same part as the wrapped empyema, but sinus connectivity is not ruled out.