A Novel Approach to the Management of the Diabetic Foot: Metatarsal Excision in the Treatment of Osteomyelitis

Freeman, Gil; Mackie, Karen; Sare, Janice Leigh; Walsh, Annie; Pherwani, AD

doi:10.1016/j.ejvs.2006.10.008

Cited by 9 publications

(5 citation statements)

References 2 publications

(2 reference statements)

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“…Accordingly, efforts have been made to limit amputation to patients with diabetic foot osteomyelitis [9]. One option is to perform a conservative surgery without local or high‐level amputation, followed by prolonged antibiotic therapy [10,11]. Some physicians advocate conservative nonsurgical management of diabetic osteomyelitis [8].…”

Section: Introductionmentioning

confidence: 99%

Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis

Lesens

Desbiez

Vidal

et al. 2011

Clinical Microbiology and Infection

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Surgical percutaneous bone biopsy specimen after a 14-day antibiotic-free period represents the gold standard of care for diabetic foot osteomyelitis but may be difficult to implement in many institutions. We evaluate a simplified strategy based on the results of per-wound bone specimen culture. For that purpose, we retrospectively reviewed the charts of 80 consecutive patients with diabetic osteomyelitis and bone sample obtained via the wound after a careful debridement. The outcome was defined as favourable if there was a complete healing of the wound with no sign of infection and stable or improved bone X-ray 6 months after antibiotic therapy completion. Culture of bone specimens was positive in 96% of patients, although half of the patients did receive a course of antimicrobials within 14 days of the bone specimen being obtained. A total of 129 bacterial isolates were obtained from bone cultures with a mean of 1.6 ± 1 isolates per patient (Staphylococcus aureus: 33%; central nervous system: 14%; streptococci: 9%; enterococci: 12%; corynebacteria: 4%; Gram-negative bacilli: 20%; anaerobes: 4%). Forty-six percent of cultures were monomicrobial. The mean duration of follow-up from diagnosis was 17 ± 1 months. Six months after discontinuation of antibiotic, six patients (7.5%) had died, nine were considered as therapeutic failures and 65 were considered as cured. Fifty-four of these 65 patients had follow-up data available at 1 year and remained in remission. In conclusion, a simplified procedure based on the culture of bone sample obtained via the ulcer after a careful debridement of the wound is effective in the medical management of diabetic foot osteomyelitis.

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Section: Introductionmentioning

confidence: 99%

Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis

Lesens

Desbiez

Vidal

et al. 2011

Clinical Microbiology and Infection

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“…Our findings are in line with those following surgeries such as internal pedal amputation of the toes and metatarsals. 20,22 With significantly better healing rate and fewer complications, surgery has been found to compare better with NST in the treatment of diabetic forefoot ulcers. 34,35 An impartial analysis of the literature reporting results of nonsurgical management reveals a dim picture; the clinical outcomes are found to be far less than optimal throughout the literature.…”

Section: Discussionmentioning

confidence: 99%

“…15-17 To address the high recurrence after NST treatment, surgery including radical debridement and ostectomy has been recommended. 18-22 Some of these authors described toe-sparing and ray-sparing techniques in the aim of avoiding amputations while conserving an acceptable length and esthetic. The early reported results in the literature were very promising in terms of ulcer and bone infection healing rates.…”

Section: Introductionmentioning

confidence: 99%

Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers: A Meta-Analysis of Comparative Studies

Yammine

Assi

2020

The International Journal of Lower Extremity Wounds

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The treatment of diabetic foot ulcers (DFUs) is usually based on local debridement, topical agents, and nonsurgical off-loading. When compared with nonsurgical methods, a number of articles reported better results with surgery. The aim of this meta-analysis was to collate quantitative evidence on the outcomes of surgery versus nonsurgical treatment (NST) of DFUs. Databases were searched from inception to September 2019. PRISMA guidelines were followed, and the Joanna Briggs Institute critical appraisal tools were used to appraise studies’ quality. Nine studies were included totalizing 436 ulcers (216 treated with surgery and 220 DFUs with NST). The primary outcome was the healing rate. The secondary outcomes were time to heal, recurrence rate, transfer rate, infection rate, and amputation/revision surgery rate. The risk differences (RDs) between the healing rates following surgery and NST for infected and noninfected ulcers were 17% (95% confidence interval [CI] = 0.012-0.328, P = .03) and 19.2% (95% CI = 0.050-0.334, P = .008), respectively, in favor of surgery. The amputation/revision surgery rate was significantly better following surgery for both types of ulcers. Noninfected ulcers demonstrated significantly lesser time to heal, recurrence, and infection rates following surgery. This meta-analysis demonstrated that surgery was superior to NST in treating infected and noninfected neuropathic plantar wounds.

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“…As previously shown, metatarsal head resection is a very useful procedure employed by different study groups in cases with or without osteomyelitis. 4,5,15,[35][36][37] Two techniques can be used to remove the infected metatarsal head: the dorsal or plantar approach. After removing the infected bone, the surgical wound must be properly managed.…”

Section: Osteomyelitis Of the Metatarsophalangeal Joint Of The Lessermentioning

confidence: 99%

Conservative Surgery of Diabetic Forefoot Osteomyelitis

Aragón‐Sánchez

Lázaro‐Martínez

Álvaro‐Afonso

et al. 2014

The International Journal of Lower Extremity Wounds

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Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection. Several issues should be taken into account when considering surgery for treating diabetic foot osteomyelitis. It is necessary to have a surgeon available with diabetic foot expertise. Regarding location of diabetic foot osteomyelitis, it is important to consider whether isolated bone or a joint is involved. In cases in which osteomyelitis is associated with a bone deformity, surgery should be able to correct this. The surgeon should always reflect about whether extensive/radical surgery could destabilize the foot. The forefoot is the most frequent location of diabetic foot osteomyelitis and is associated with better prognosis than midfoot and hindfoot osteomyelitis. Many surgical procedures can be performed in patients with diabetes and forefoot ulcers complicated by osteomyelitis while avoiding amputations. Performing conservative surgeries without amputations of any part of the foot is not always feasible in cases in which the infection has destroyed the soft tissue envelope. Attempting conservative surgery in such cases risks infected tissues remaining in the wound bed leading to failure. The election of different surgical options depends on the expertise of the surgeons selected for the multidisciplinary teams. It is the aim of this article to provide a sample of surgical techniques in order to remove the bone infection from the forefoot while avoiding amputations.

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A Novel Approach to the Management of the Diabetic Foot: Metatarsal Excision in the Treatment of Osteomyelitis

Abstract: In diabetic patients, metatarsal excision may be better than transmetatarsal amputation.

Cited by 9 publications

References 2 publications

Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis

Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis

Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers: A Meta-Analysis of Comparative Studies

Conservative Surgery of Diabetic Forefoot Osteomyelitis

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