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10. Medical and minor surgical procedures
Pyomyositis
– P y o m y o sitis is an infectio n o f the m uscle, alm o st alway s d ue to Staphylococcus aureus.
It m o st co m m o nly affects the m uscles o f the lim bs and to rso . T hese infectio ns m ay
o ccur sim ultaneo usly in m ultip le sites.
– D uring th e early ind urated stage, w h ile th e m uscle is swo llen, h o t and p ainful,
m ed ical treatm ent m ay be effective. D uring the sup p urative stage, when the abscess
has fo rm ed , surgical d rainage is the o nly effective treatm ent.
Treatment
Medical treatment (ind urated stage)
– Im m o bilise the lim b.
– A ntibio tic therap y as fo r o ther abscesses (see p age 2 7 4 ).
– A d ap t analgesics to the p ain level (see Pain, p age 2 9 ).
– A p p ly co m p resses so ak ed in 7 0 % alco ho l, 2 tim es/ d ay (m axim um o f 3
tim es/ d ay to
p revent burns to the sk in).
Surgical drainage (sup p urative stage)
T reatm ent o f p y o m y o sitis is by incisio n fo llo wing the rules fo r incisio n o f abscesses
d escribed o n p age 2 7 5 . M uscle abscesses are o ften d eep er than o ther abscesses. A s a
result, need le asp iratio n w ith a large bo re need le m ay be necessary to lo cate th e
abscess; it y ield s thick p us. N eed le asp iratio n is insufficient treatm ent even if p us is
evacuated .
Material and anaesthesia
A s fo r abscesses (see p ages 2 7 4 and 2 7 5 ).
Technique
– G enero us incisio n alo ng the axis o f the lim b, o ver the site o f the abscess and avo id ing
und erly ing neuro vascular stuctures; incise th e sk in, subcutaneo us tissues and 10
m uscular fascia with a scalp el (F igure 1 1 a).
– D issect th e m uscle fibres with no n- to o th ed fo rcep s ( Kelly ty p e) o r ro und tip p ed
scisso rs. I nsert the instrum ent into the m uscle until th e p urulent cavity is reached .
D uring insertio n, k eep the instrum ent clo sed and p erp end icular to the m uscle fibres.
W ith d raw gently with th e scisso rs o r fo rcep s sligh tly o p en, k eep ing instrum ent
p erp end icular to the fibres (F igure 1 1 b).
– U se a fo refinger to exp lo re the cavity , break d o wn any lo culi and evacuate the p us
(F igure 1 1 c).
– W ash abund antly with antisep tic so lutio n.
– Insert a large d rain.
– aFbioxutht ethde r5aindtoayth(eFeidgugreeo1f1thde).wo und using a single suture. Rem o ve the d rain o n
th
279
Pyomyositis
– P y o m y o sitis is an infectio n o f the m uscle, alm o st alway s d ue to Staphylococcus aureus.
It m o st co m m o nly affects the m uscles o f the lim bs and to rso . T hese infectio ns m ay
o ccur sim ultaneo usly in m ultip le sites.
– D uring th e early ind urated stage, w h ile th e m uscle is swo llen, h o t and p ainful,
m ed ical treatm ent m ay be effective. D uring the sup p urative stage, when the abscess
has fo rm ed , surgical d rainage is the o nly effective treatm ent.
Treatment
Medical treatment (ind urated stage)
– Im m o bilise the lim b.
– A ntibio tic therap y as fo r o ther abscesses (see p age 2 7 4 ).
– A d ap t analgesics to the p ain level (see Pain, p age 2 9 ).
– A p p ly co m p resses so ak ed in 7 0 % alco ho l, 2 tim es/ d ay (m axim um o f 3
tim es/ d ay to
p revent burns to the sk in).
Surgical drainage (sup p urative stage)
T reatm ent o f p y o m y o sitis is by incisio n fo llo wing the rules fo r incisio n o f abscesses
d escribed o n p age 2 7 5 . M uscle abscesses are o ften d eep er than o ther abscesses. A s a
result, need le asp iratio n w ith a large bo re need le m ay be necessary to lo cate th e
abscess; it y ield s thick p us. N eed le asp iratio n is insufficient treatm ent even if p us is
evacuated .
Material and anaesthesia
A s fo r abscesses (see p ages 2 7 4 and 2 7 5 ).
Technique
– G enero us incisio n alo ng the axis o f the lim b, o ver the site o f the abscess and avo id ing
und erly ing neuro vascular stuctures; incise th e sk in, subcutaneo us tissues and 10
m uscular fascia with a scalp el (F igure 1 1 a).
– D issect th e m uscle fibres with no n- to o th ed fo rcep s ( Kelly ty p e) o r ro und tip p ed
scisso rs. I nsert the instrum ent into the m uscle until th e p urulent cavity is reached .
D uring insertio n, k eep the instrum ent clo sed and p erp end icular to the m uscle fibres.
W ith d raw gently with th e scisso rs o r fo rcep s sligh tly o p en, k eep ing instrum ent
p erp end icular to the fibres (F igure 1 1 b).
– U se a fo refinger to exp lo re the cavity , break d o wn any lo culi and evacuate the p us
(F igure 1 1 c).
– W ash abund antly with antisep tic so lutio n.
– Insert a large d rain.
– aFbioxutht ethde r5aindtoayth(eFeidgugreeo1f1thde).wo und using a single suture. Rem o ve the d rain o n
th
279
