Osteomyelitis in diabetic foot: A comprehensive overview

Giurato, Laura; Meloni, Marco; Izzo, Valentina; Uccioli, Luigi

doi:10.4239/wjd.v8.i4.135

Cited by 135 publications

(102 citation statements)

References 57 publications

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“…The initial soft tissue infection may spread into the bone resulting in diabetic foot osteomyelitis and thus a high risk of amputation. Osteomyelitis should be suspected in all DFU patients with clinical findings of infection and in chronic or recurrent wounds [2]. Early identification of this clinical entity is crucial for the overall management and in order to reduce mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

Velissaris

Pantzaris

Platanaki

et al. 2018

Romanian Journal of Internal Medicine

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Diabetic foot ulcers (DFUs) are a very common cause of mortality and morbidity. The distinction between infected and non-infected DFU remains a very challenging task for clinicians in everyday practice. Even when infection is documented, the spectrum of diabetic foot infection is wide, ranging from cellulitis and soft tissue infection to osteomyelitis. Procalcitonin (PCT), a well-established sepsis biomarker, has been used in the diagnosis of several infections including osteomyelitis in patients with diabetes mellitus. This review gathers and presents all the relevant data, up until now, regarding the use of PCT as an assessment tool in diabetic patients with foot infection. Current evidence suggests that PCT levels could aid clinicians in distinguishing infected from non-infected DFUs as well as in the distinction between soft tissue infection and bone involvement, but further and larger studies are warranted to confirm these findings.

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Section: Introductionmentioning

confidence: 99%

Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

Velissaris

Pantzaris

Platanaki

et al. 2018

Romanian Journal of Internal Medicine

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“…Chronic osteomyelitis of the foot bones, including in the diabetic foot, should be diagnosed early and accurately to ensure effective treatment and reduce the risk of extensive amputation [12,13].…”

Section: Discussionmentioning

confidence: 99%

Structural reorganization of the cartilage tissue in chronic osteomyelitis of the foot bones

Ступина¹,

Migalkin²,

Sudnitsyn³

2019

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Purpose To study structural reorganization of the cartilage tissue of the joints, depending on the location of osteomyelitis in the bones of the foot. Materials and methods Intraoperative material of 16 patients with chronic osteomyelitis in the foot bones was studied (10 males in the average age 45.3 (33 ÷ 56) years and six females in the average age of 40 (23 ÷ 53) years). The material was resected fragments of the osteo-cartilaginous complex: calcaneus, talus and adjacent joint tissue (subtalar and talo-navicular, phalangeal and metatarsal bones and metatarsophalangeal joint). The material was fixed in 10 % formalin. Paraffin sections (5-7 μm thick) were stained with hematoxylin and eosin. Histological studies were performed using a stereo microscope "AxioScope.A1" with a digital camera "AxioCam" and software "Zenblue" (CarlZeiss MicroImaging GmbH, Germany). Results The subchondral bone plate and basophilic line remained continuous and the vessels did not penetrate into the cartilaginous tissue in chronic osteomyelitis of the calcaneus and talus, when the osteomyelitis foci were remote from the articular surface. If an osteomyelitic lesion was present in the subchondral zone, abnormalities in the articular cartilage were detected both from the side of the subchondral bone and on the articular surface; and vascular invasion was observed. In the deep zone of the cartilage, there were hypertrophic chondrocytes with signs of chondroptosis, what indicated a violation of the chondrohematic barrier. Disorders of the basophilic line and penetration of the bone marrow pannus were revealed. From the side of the articular surface, a synovial pannus was observed invading the cartilage matrix. In chronic osteomyelitis of the phalanges and metatarsal bones, regardless of the phase of the inflammatory process, in all observations, disorders in the structure of the subchondral bone plate and articular cartilage were detected; there was invasion of blood vessels from the subchondral zone and articular surface that might be explained by the small size of those bones. Conclusion The intensity of articular cartilage destruction in chronic osteomyelitis of the calcaneus and talus depended on the location of the osteomyelitis focus and the phase of the inflammatory process. In chronic osteomyelitis of the phalanges and metatarsal bones, regardless of the phase of the inflammatory process, there were disorders in the structure of the articular cartilage and vascular invasion. The findings on structural changes in the articular cartilage in chronic osteomyelitis of adjacent bones are helpful for defining the tactics of surgical treatment.

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“…Patients were separated based on the Cierny-Mader classification system defining the depth as well as diffusion of osteomyelitis [8,9,20] . Patients with Charcot collapse, critical limb ischemia (defined by vascular imaging proven: single vessel run-off, multi-level or multivessel arterial disease) and diabetes mellitus were separated into a subgroup for analysis of their unique pathophysiology.…”

Section: Patient Datamentioning

confidence: 99%

Limb preservation with suprafascial and thin perforator flaps: salvaging osteomyelitis, Charcot collapse and critical limb ischemia

Diamond¹,

Doval²,

Scott³

et al. 2019

PAR

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Aim: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine patient and flap related outcomes in advanced lower extremity disease. Methods:The authors conducted a retrospective review of fasciocutaneous free flaps of variable thickness for lower extremity salvage. Osteomyelitis and non-osteomyelitis patients were compared according to our primary outcome measures: functional ambulation, bone healing and complications to flap and patient. Subgroups with critical limb ischemia, Charcot collapse and diabetic foot were analyzed separately.Results: Fifty-nine patients underwent free flap reconstruction: osteomyelitis (n = 20, 34%), Charcot collapse (n = 22, 37%), and/or critical limb ischemia (n = 12, 20%). All patients underwent anterolateral thigh flaps tailored for defectspecific thicknesses: 17 superthin, 25 suprafascial, 17 subfascial. There were no significant differences between groups in terms of partial and complete flap loss (P = 1.000 and P = 0.108). Ninety-one percent of patients were ambulatory at follow up. Eighty-five percent of individuals with osteomyelitis cleared their infection demonstrating radiographic bone healing. Two patients developed recalcitrant deep space infections ultimately requiring amputation. Subgroup analysis did not show any differences in flap related complications within the diabetic Charcot population. In multivariate regression, preoperative revascularization was independently associated with failure of limb salvage. Conclusion:Primarily thinned perforator flaps performed well in the setting of lower extremity limb salvage, critical limb ischemia, osteomyelitis, and the Charcot foot -expanding their role in the armamentarium for lower extremity care.

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Osteomyelitis in diabetic foot: A comprehensive overview

Cited by 135 publications

References 57 publications

Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

Procalcitonin as a diagnostic and prognostic marker in diabetic foot infection. A current literature review

Structural reorganization of the cartilage tissue in chronic osteomyelitis of the foot bones

Limb preservation with suprafascial and thin perforator flaps: salvaging osteomyelitis, Charcot collapse and critical limb ischemia

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