A Cahn1, Kleinman Y. 1. The diabetes Research Center, Hadassah Hebrew University Hospital, Jerusalem, Israel.
Abstract
UNLABELLED: Diabetic foot abscesses are an occasional complication of diabetic foot infections usually involving osteomyelitis and significant soft tissue injury. The standard of care for diabetic foot abscesses is the performance of immediate surgical drainage and debridement. However, this therapeutic mode involves more often than not, some extent of minor amputation and bony loss. With the advent of new therapeutic techniques it may be possible to treat diabetic foot abscesses conservatively. OBJECTIVE: To explore adjunct therapies in the treatment of diabetic foot abscesses in order to avoid extensive surgery, amputation and tissue loss whilst maintaining limb integrity. METHOD AND RESULTS: Between January 2011 and June 2012, six patients with a diabetic foot abscess and osteomyelitis presented at our diabetic foot clinic. They were treated with topical oxygen and the abscesses were drained using PolyMem® Wic® Silver Rope (PWSR). All patients experienced full recovery and remained disease free during a follow up period of 4-21 months. CONCLUSION: Amputation and the removal of infected bone had once been considered the sole treatment for diabetic foot osteomyelitis. Multiple case series and accumulation of clinical experience has shown otherwise, and nowadays medical management of osteomyelitis is the preferred treatment in select patients. In our study, we present a case series of patients suffering from diabetic foot abscesses treated non-surgically. Hopefully this series will lay the foundation for further data demonstrating the feasibility of a conservative approach for diabetic foot abscesses, which may overcome the infection without requiring amputation.
UNLABELLED: Diabetic foot abscesses are an occasional complication of diabetic foot infections usually involving osteomyelitis and significant soft tissue injury. The standard of care for diabetic foot abscesses is the performance of immediate surgical drainage and debridement. However, this therapeutic mode involves more often than not, some extent of minor amputation and bony loss. With the advent of new therapeutic techniques it may be possible to treat diabetic foot abscesses conservatively. OBJECTIVE: To explore adjunct therapies in the treatment of diabetic foot abscesses in order to avoid extensive surgery, amputation and tissue loss whilst maintaining limb integrity. METHOD AND RESULTS: Between January 2011 and June 2012, six patients with a diabetic foot abscess and osteomyelitis presented at our diabetic foot clinic. They were treated with topical oxygen and the abscesses were drained using PolyMem® Wic® Silver Rope (PWSR). All patients experienced full recovery and remained disease free during a follow up period of 4-21 months. CONCLUSION: Amputation and the removal of infected bone had once been considered the sole treatment for diabetic foot osteomyelitis. Multiple case series and accumulation of clinical experience has shown otherwise, and nowadays medical management of osteomyelitis is the preferred treatment in select patients. In our study, we present a case series of patients suffering from diabetic foot abscesses treated non-surgically. Hopefully this series will lay the foundation for further data demonstrating the feasibility of a conservative approach for diabetic foot abscesses, which may overcome the infection without requiring amputation.
Authors: Ka-Kit Tsang; Enid Wai-Yung Kwong; Kevin Y Woo; Tony Shing-Shun To; Joanne Wai-Yee Chung; Thomas Kwok-Shing Wong Journal: Evid Based Complement Alternat Med Date: 2015-07-28 Impact factor: 2.629