sequestration

Small dead bones can often be liquefied into pus, or discharged into the body or soft tissue with pus. However, the larger dead bone can not be discharged, and remains in the bone cavity to become a foreign body, which is the root cause of the infection persisting and must be surgically removed. Preoperative x-ray films proved that the dead bones existed and were completely separated from the surrounding tissues. There were enough new bone capsules around them. It is estimated that surgery should not be performed when the pathological fractures do not occur under the protection. Treatment of diseases: comminuted fractures Indication 1. Large bones that cannot be absorbed by the body. 2. A foreign body in the bone cavity that causes repeated infection of the body. 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. Position, incision: body position depends on the incision. Inflatable tourniquet for limb surgery. The design of the incision should be based on the position of the dead bone displayed on the x-ray film to select the most direct route to tissue damage. If you enter along the sinus, you can usually reach the lesion; if the sinus is located around important nerves, blood vessels, or too far from the lesion, you should consider a safer and more direct route. 2. Expose the lesion: If you plan to enter the lesion along the sinus, you can use the probe to understand the direction of the sinus and use it as a guide. Then, cut the skin according to the length required and remove the sinus and scar tissue. The soft tissue is separated and reaches the bone surface. Cut the periosteum and peel it off to the sides (not too wide, so as not to affect the bone blood transport), you can reveal the lesion. 3. Clear the lesion: the bone of the bone can be seen as rough and uneven, with multiple bone pupils, and locate the dead bone according to the local and x-ray indications. For dead bones that cannot be removed, a small amount of bone around them should be removed and the opening should be enlarged to remove the dead bones with a rongist. Thoroughly exclude the necrotic tissue and inflammatory granules in the sinus cavity, sinus tract, thoroughly remove the pus, send bacterial culture and antibiotic sensitivity test, and repeatedly wash the bone cavity and wound with sterile saline. Then, relax the tourniquet and stop the bleeding completely. 4. Wound treatment: the residual bone cavity is shallow and small, and the blood supply is better. If the lesion is completely removed, the antibiotics can be placed in the first stage after suturing, or the Vaseline gauze is placed in the drainage, and the ends of the incision are loosely sutured. If the residual bone cavity is large, further closed lavage, negative pressure drainage therapy, dishing or bone cavity filling is needed.

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