Title : Limb salvage in moderately to severely infected diabetic foot ulcer with wound debridement and intraosseous antibiotic application
Abstract:
Introduction
Diabetic foot ulcers are one of the most common morbid consequences of poorly controlled diabetes. 20 percentage of moderate to severe diabetic foot infections results in major lower limb amputations.
Aim:
To analyse whether adding intraosseous local antibiotics reduces the rate of major lower limb amputations in diabetic foot osteomyelitis.
Methodology:
42 patients admitted with diabetic foot osteomyelitis were treated with debridement and local intraosseous antibiotic application. There were four infected hindfoot Charcot, six infected midfoot Charcot, five heel ulcer, five midfoot ulcer and 22 forefoot osteomyelitis cases. All these patients had diabetic foot multidisciplinary team (MDT) assessment.
Results:
There were 32 males and 10 females. The mean age was 61.2 years (42-87 years). 10 staged Charcot foot reconstructions, five partial calcanectomy, five transmetatarsal amputations and 22 forefoot debridement/amputations were performed. Eight forefoot and two heel wound patients needed resurgery. Two of them were below knee amputations, three were transmetatarsal amputations and the rest were further bone shortenings. Four patients in this group needed vascular procedures. The wound took 2-8 months to heal fully with a mean time of 5 months. Two patients were found to be deceased on long term follow-up. Major amputation was prevented in 95% of moderate to severe diabetic foot infections. Our reoperation rate after primary surgery was only 19%.
Conclusion:
Our study shows that local intraosseous antibiotic application can reduce major amputation rates in moderately to severely infected diabetic foot and give a functional limb to the patient.
Keywords: diabetic foot, intraosseous antibiotic, amputation
Audience Take Away:
Amputation rates associated with moderate to severe diabetic foot infections
How local intraosseous antibiotic application could help reduce major amputation rates in moderately to severely infected diabetic foot cases.
Role of diabetic foot MDT in managing diabetic foot infections.
Foot and ankle surgeons could benefit from the knowledge gained from the results of this study and use it in the management of severe diabetic foot infections.
