AIMS/HYPOTHESIS: We analysed the factors that determine the outcomes of surgical treatment of osteomyelitis of the foot in diabetic patients given early surgical treatment within 12 h of admission and treated with prioritisation of foot-sparing surgery and avoidance of amputation. METHODS: A consecutive series of 185 diabetic patients with foot osteomyelitis and histopathological confirmation of bone involvement were followed until healing, amputation or death. RESULTS: Probing to bone was positive in 175 cases (94.5%) and radiological signs of osteomyelitis were found in 157 cases (84.8%). Staphylococcus aureus was the organism isolated in the majority of cultures (51.3%), and in 35 cases (36.8%) it proved to be methicillin-resistant. The surgical treatment performed included 91 conservative surgical procedures, which were defined as those where no amputation of any part of the foot was undertaken (49.1%). A total of 94 patients received some degree of amputation, consisting of 79 foot-level (minor) amputations (42.4%) and 15 major amputations (8%). Five patients died during the perioperative period (2.7%). Histopathological analysis revealed 94 cases (50.8%) of acute osteomyelitis, 43 cases (23.2%) of chronic osteomyelitis, 45 cases (24.3%) of acute exacerbation of chronic osteomyelitis and three remaining cases (1.6%) designated as 'other'. The risks of failure in the case of conservative surgery were exposed bone, the presence of ischaemia and necrotising soft tissue infection. CONCLUSIONS/ INTERPRETATION: Conservative surgery without local or high-level amputation is successful in almost half of the cases of diabetic foot osteomyelitis. Prospective trials should be undertaken to determine the relative roles of conservative surgery versus other approaches.
AIMS/HYPOTHESIS: We analysed the factors that determine the outcomes of surgical treatment of osteomyelitis of the foot in diabeticpatients given early surgical treatment within 12 h of admission and treated with prioritisation of foot-sparing surgery and avoidance of amputation. METHODS: A consecutive series of 185 diabeticpatients with foot osteomyelitis and histopathological confirmation of bone involvement were followed until healing, amputation or death. RESULTS: Probing to bone was positive in 175 cases (94.5%) and radiological signs of osteomyelitis were found in 157 cases (84.8%). Staphylococcus aureus was the organism isolated in the majority of cultures (51.3%), and in 35 cases (36.8%) it proved to be methicillin-resistant. The surgical treatment performed included 91 conservative surgical procedures, which were defined as those where no amputation of any part of the foot was undertaken (49.1%). A total of 94 patients received some degree of amputation, consisting of 79 foot-level (minor) amputations (42.4%) and 15 major amputations (8%). Five patients died during the perioperative period (2.7%). Histopathological analysis revealed 94 cases (50.8%) of acute osteomyelitis, 43 cases (23.2%) of chronic osteomyelitis, 45 cases (24.3%) of acute exacerbation of chronic osteomyelitis and three remaining cases (1.6%) designated as 'other'. The risks of failure in the case of conservative surgery were exposed bone, the presence of ischaemia and necrotising soft tissue infection. CONCLUSIONS/ INTERPRETATION: Conservative surgery without local or high-level amputation is successful in almost half of the cases of diabetic foot osteomyelitis. Prospective trials should be undertaken to determine the relative roles of conservative surgery versus other approaches.
Authors: John M Embil; Greg Rose; Elly Trepman; Mary Cheang M Math; Frank Duerksen; J Neil Simonsen; Lindsay E Nicolle Journal: Foot Ankle Int Date: 2006-10 Impact factor: 2.827
Authors: D P Murdoch; D G Armstrong; J B Dacus; T J Laughlin; C B Morgan; L A Lavery Journal: J Foot Ankle Surg Date: 1997 May-Jun Impact factor: 1.286
Authors: M L Grayson; G W Gibbons; G M Habershaw; D V Freeman; F B Pomposelli; B I Rosenblum; E Levin; A W Karchmer Journal: Clin Infect Dis Date: 1994-05 Impact factor: 9.079
Authors: Kyrstin L Lane; Mohammed S Abusamaan; Betiel Fesseha Voss; Emilia G Thurber; Noora Al-Hajri; Shraddha Gopakumar; Jimmy T Le; Sharoon Gill; Jaime Blanck; Laura Prichett; Caitlin W Hicks; Ronald L Sherman; Christopher J Abularrage; Nestoras N Mathioudakis Journal: J Diabetes Complications Date: 2020-05-22 Impact factor: 2.852
Authors: Dane K Wukich; Kimberlee B Hobizal; Tresa L Sambenedetto; Kristin Kirby; Bedda L Rosario Journal: Foot Ankle Int Date: 2016-08-22 Impact factor: 2.827
Authors: Madlaina Schöni; Felix W A Waibel; David Bauer; Tobias Götschi; Thomas Böni; Martin C Berli Journal: Arch Orthop Trauma Surg Date: 2020-04-07 Impact factor: 3.067
Authors: José Luis Lázaro-Martínez; Marta García-Madrid; Yolanda García-Álvarez; Francisco Javier Álvaro-Afonso; Irene Sanz-Corbalán; Esther García-Morales Journal: J Clin Orthop Trauma Date: 2020-12-15