Limb salvage for spreading midfoot osteomyelitis following diabetic foot surgery

Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved

“…Limb salvage was successfully achieved in high‐risk cases in which a major amputation had been indicated in the patients’ teaching hospitals. We applied the same principles that we used to achieve limb salvage in two cases with post‐operative mid‐foot spreading osteomyelitis : (1) the infected bone was partially removed; (2) culture‐guided post‐operative antibiotic treatment; (3) bed rest before placing the total contact cast; and (4) the unstable foot was stabilized using a total contact cast with opening for performing wound care and to check the healing course. The changes of the total contact cast were performed weekly in order to evaluate the foot and monitor complications, such as spreading infection, necrosis or pressure ulcers.…”

Conservative surgery and postoperative antibiotics guided by bone biopsies for diabetic foot osteomyelitis. Comments on Nguyen S, et al. conservative surgical treatment for metatarsal osteomyelitis in diabetic foot: Experience of two French centres

“…1 We are enthusiastic to know that other groups are using the approach we have been promoting since 2008. [2][3][4][5][6][7][8] First reported by Ha-Van et al, 9 we consider it an excellent alternative to amputation in selected cases. Skilled surgeons are essential in performing this type of surgery, which also requires appropriate follow-up in a multidisciplinary setting.…”

A Two-Stage Diabetic Foot Salvage Using Synthetic Bone Void Filler and Lesser Toe Fillet Flap

“…The presence of soft-tissue infection and osteomyelitis alone prevents primary wound closure, but surgical debridement and bone resection can also lead to a large soft-tissue void that adds further complexity to soft-tissue reconstruction. 1-3…”

“…The presence of soft-tissue infection and osteomyelitis alone prevents primary wound closure, but surgical debridement and bone resection can also lead to a large soft-tissue void that adds further complexity to soft-tissue reconstruction. [1][2][3] An antibiotic-impregnated cement spacer has been described to fill the cavity created by debridement and resolve residual soft-tissue and osseous infections in a diabetic foot [4][5][6][7] . More recently, the use of a synthetic bone void filler composed of 40% hydroxyapatite and 60% calcium sulfate (CERAM-ENT) has been described in the treatment of diabetic foot osteomyelitis as an alternative local antibiotic carrier to bone cement 8 .…”