acute osteomyelitis incision and drainage

Acute blood-borne suppurative osteomyelitis (abbreviated as acute osteomyelitis) occurs mostly in children, and occurs in the metaphysis of long bones, most commonly in the femur and tibia. Early diagnosis and early treatment are the key to improving the cure rate and preventing disability. Early treatment includes early, adequate, effective systemic antibiotic therapy and supportive therapy, and timely localized decompression, drainage (including bone marrow drilling or windowing) to relieve pressure on the intraosseous abscess and avoid the medulla Cavity diffusion prevents and reduces bone destruction and necrosis. Antibiotics should continue to be used after surgery until the inflammation disappears. Treatment of diseases: acute blood-borne osteomyelitis, suppurative osteomyelitis Indication 1. Once the acute osteomyelitis is diagnosed clearly, if the systemic treatment with antibiotics and other systemic effects are not obvious, it should be cut open in the bone or the medullary cavity for exploration in the lesion area. If there is pus, the window should be drained. 2. Local puncture confirmed subperiosteal abscess or x-ray film showed subperiosteal shadow thickening, in addition to incision drainage, should be medullary drainage. 3. Subperiosteal abscess penetrates into soft tissue and forms an abscess. At the same time, soft tissue abscess and intramedullary abscess should be drained. Contraindications 1. The blood coagulation mechanism has serious obstacles. 2. Hypertension, diabetes, and some bleeding-prone diseases. Preoperative preparation Acute osteomyelitis is associated with more severe symptoms of systemic sepsis or sepsis, and most of the sick children are more severe. In order to enable the sick child to tolerate surgery, the following measures should be taken before surgery to improve the general condition: 1. Systematic application of adequate, sensitive antibiotics to control infection. 2. If the general condition is weak, anemia, serious illness or toxic shock, active blood transfusion, infusion, correction of dehydration, acidosis, etc., should be performed after the condition is improved. 3. The diseased limb is pulled or externally fixed to brake and raise the affected limb. Surgical procedure Take the upper humeral osteomyelitis as an example: 1. Position, incision: supine position. The anterior medial incision or the incision at the most obvious part of the sign is 3 to 5 cm long. The midpoint of the incision should be located at the most obvious point of clinical tenderness and swelling. 2. Exposure, drilling and exploration: Incision of the skin, often found periosteal edema, hypertrophy or was lifted by subperiosteal abscess. If there is subperiosteal abscess, it is confirmed by puncture that the periosteum is cut open and the pus is drained and sent to culture. If there is no pus, the cortical bone in the lesion area is often slightly rough and gray. The periosteum can be slightly peeled off to both sides (the peeling is reduced as much as possible to ensure the blood supply to the bone), and several bone drilled holes are drilled directly to the bone marrow cavity to detect the presence or absence of the bone marrow cavity abscess. If there is no pus overflow in the medullary cavity, the drilling has reached the decompression effect, that is, the operation is terminated, and the incision is sutured after the local antibacterial drug is placed. 3. Open the window to expand the drainage: If there is pus flowing out of the medullary cavity after drilling, the bone chisel should be used to cut off the cortical bone of 1cm wide and appropriate length in the drilling part, and open the window for smooth drainage. Rinse with normal saline to remove necrotic tissue and free broken bone fragments, but do not scrape in the medullary cavity to avoid spreading infection. 4. Drainage and suture: absorb the pus, wash the wound, put in the green, streptomycin powder or other sensitive antibiotics, loosely suture the incision, put a plastic tube in the deep part of the incision to facilitate postoperative drainage, irrigation and injection treatment . Patients with large pus and multi-lumen can be placed in double-tube closed lavage negative pressure drainage. If the bone is severely damaged and the pus is thick, the drainage strip should be placed in the open window of the bone to open the drainage. complication Bone destruction.