surgery
Last reviewed 01/2018
Surgery should be postponed until there are significant symptoms combined with clear evidence of a sequestrum.
Sulphan blue is injected preoperatively; this stains all vital tissue green, leaving dead tissue unstained. Under antibiotic cover, the surgeon removes all dead i.e. unstained - tissues and bone.
There are several strategies to prevent reinfection and promote healing:
- double lumen tubes are left in the lumen and antibiotic solution is introduced and aspirated 4 hourly; this is continued until the aspirate is sterile (3-6 weeks) and then the tube is gradually removed
- the cavity may be packed with gentamicin beads
- the cavity may be packed with multiple small bone grafts
- a muscle flap with an intact blood supply may be laid into the cavity