Evaluation of Adjuvant Antibiotic Loaded Injectable Bio-Composite Material in Diabetic Foot Osteomyelitis and Charcot Foot Reconstruction

Abstract

The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27–83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8–45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12–98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4–42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.

The Use of a Vancomycin-Eluting Calcium Sulfate and Hydroxyapatite Composite for Dead Space Management in a Fracture-Related Infection (FRI): A Retrospective Case Series

“…One of these biodegradable ceramics is Cerament (CERAMENT BONE VOID FILLER, Bonesupport, Lund, Sweden), a combination of calcium sulfate (CaS) and hydroxyapatite (HA), which has shown high osteoconductivity in bone voids after tibial plateau fractures [ 9 ]. The addition of gentamicin (CG, CERAMENT G, Bonesupport, Lund, Sweden) can protect bone healing from gentamicin-sensitive microorganisms and has shown excellent results in FRI and osteomyelitis [ 4 , 10 , 11 ]. While CG has been investigated well in recent years, data on CG’s sister product, CV (CV, CERAMENT V, Bonesupport, Lund, Sweden), where vancomycin is added to CaS/HA, is rather scarce.…”