Outcome of limited forefoot amputation with primary closure in patients with diabetes

Shaikh, Nadia; Vaughan, Phillip W.; Varty, K.; Coll, Anthony P.; Robinson, A. H. N.

doi:10.1302/0301-620x.95b8.31280

Cited by 26 publications

(31 citation statements)

References 20 publications

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“…One hundred eighty‐two full‐text articles were assessed for eligibility, and 133 (65 reviews, eight studies of duplicated population, and 60 studies with data that cannot be extracted) of them were removed since they did not meet our selection criteria. Finally, 49 articles were included in our meta‐analysis after full‐text review …”

Section: Resultsmentioning

confidence: 99%

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Ding

Miao

et al. 2019

Diabetes Metabolism Res

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Recurrence rates of diabetic foot ulcers vary widely in the published literature. The aim of this systematic review is to estimate recurrence rates of diabetic foot ulcers. We did a PubMed search and performed a review of reference lists for studies reporting recurrence of diabetic foot ulcers. The weighted relative risk (RR) and corresponding 95% confidence interval (CI) for recurrence was estimated. Forty‐nine studies reporting recurrence of diabetic foot ulcers were included. A pooled estimate for recurrence rate was 22.1% per person‐year (py) (95% CI, 19.0‐25.2%). Recurrence rate was 24.9% per py in Europe (95% CI, 20.0%‐29.7%), 17.8% per py in North America (95% CI, 12.7%‐22.9%), 16.9% per py in Africa (95% CI, 4.7%‐29.0%), and 17.0% per py in Asia (95% CI, 11.1%‐23.0%). Turkey had the highest recurrence rate of 44.4% per py (95% CI, 24.9%‐63.9%), and Bangladesh had the lowest of 4.3% per py (95% CI, 2.3%‐6.3%). Recurrence rates of diabetic foot ulcers before 2002, between 2002 and 2008, and after 2008 were 22.2% per py (95% CI, 17.6%‐26.8%), 21.9% per py (95% CI, 17.0%‐26.8%), and 21.8% per py (95% CI, 16.3%‐27.2%), respectively. Recurrence rates of diabetic foot ulcers are high. Recurrence rates vary widely in different regions and have decreased recently. More attention towards recurrence of diabetic foot ulcers is urgently required.

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Section: Resultsmentioning

confidence: 99%

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Ding

Miao

et al. 2019

Diabetes Metabolism Res

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“…Unfortunately, available studies do not provide information to inform which types of DFO cases may be successfully treated without surgery [109,118,[223][224][225][226][227]. In some cases, limited surgery (resection of infected and necrotic bone without amputation) combined with antibiotic therapy may be most appropriate [156,[228][229][230][231]. A retrospective study from four centres in France and Spain compared outcomes of patients with bone culture-proven S. aureus DFO who were treated by either 'medical' (just antibiotic therapy, other than soft tissue debridement at the bedside) or 'surgical' (operative treatment combined with prolonged antibiotic therapy) [232].…”

Section: Treating Osteomyelitismentioning

confidence: 99%

“…Unfortunately, available studies do not provide information to inform which types of DFO cases may be successfully treated without surgery . In some cases, limited surgery (resection of infected and necrotic bone without amputation) combined with antibiotic therapy may be most appropriate . A retrospective study from four centres in France and Spain compared outcomes of patients with bone culture‐proven S .…”

Section: Introductionmentioning

confidence: 99%

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

Lipsky

Aragón‐Sánchez

Diggle

et al. 2016

Diabetes Metabolism Res

487

561

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Recommendations Classification/diagnosis Diabetic foot infection must be diagnosed clinically, based on the presence of local or systemic signs or symptoms of inflammation (strong; low). Assess the severity of any diabetic foot infection using the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification scheme (strong; moderate). Osteomyelitis For an infected open wound, perform a probe‐to‐bone test; in a patient at low risk for osteomyelitis, a negative test largely rules out the diagnosis, while in a high‐risk patient, a positive test is largely diagnostic (strong; high). Markedly elevated serum inflammatory markers, especially erythrocyte sedimentation rate, are suggestive of osteomyelitis in suspected cases (weak; moderate). A definite diagnosis of bone infection usually requires positive results on microbiological (and, optimally, histological) examinations of an aseptically obtained bone sample, but this is usually required only when the diagnosis is in doubt or determining the causative pathogen's antibiotic susceptibility is crucial (strong; moderate). A probable diagnosis of bone infection is reasonable if there are positive results on a combination of diagnostic tests, such as probe‐to‐bone, serum inflammatory markers, plain X‐ray, magnetic resonance imaging (MRI) or radionuclide scanning (strong; weak). Avoid using results of soft tissue or sinus tract specimens for selecting antibiotic therapy for osteomyelitis as they do not accurately reflect bone culture results (strong; moderate). Obtain plain X‐rays of the foot in all cases of non‐superficial diabetic foot infection (strong; low). Use MRI when an advanced imaging test is needed for diagnosing diabetic foot osteomyelitis (strong; moderate). When MRI is not available or contraindicated, consider a white blood cell‐labelled radionuclide scan, or possibly single‐photon emission computed tomography (CT) and CT (SPECT/CT) or fluorine‐18‐fluorodeoxyglucose positron emission tomography/CT scans (weak; moderate). Assessing severity At initial evaluation of any infected foot, obtain vital signs and appropriate blood tests, debride the wound and probe and assess the depth and extent of the infection to establish its severity (strong; moderate). At initial evaluation, assess arterial perfusion and decide whether and when further vascular assessment or revascularization is needed (strong; low). Microbiological considerations Obtain cultures, preferably of a tissue specimen rather than a swab, of infected wounds to determine the causative microorganisms and their antibiotic sensitivity (strong; high). Do not obtain repeat cultures unless the patient is not clinically responding to treatment, or occasionally for infection control surveillance of resistant pathogens (strong; low). Send collected specimens to the microbiology laboratory promptly, in sterile transport containers, accompanied by clinical information on the type of specimen and location of the wound (strong; low). Surgical treatment Consult...

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“…The definitive role of such procedures must be evaluated in prospective trials addressed by experienced diabetic foot teams 47. Many studies have concluded that limited surgery (resection of infected and necrotic bone without amputation) combined with antibiotic therapy may be the most appropriate treatment 49,56,57…”

Section: Diabetic Foot Osteomyelitis–treatment Options: Evidence Analmentioning

confidence: 99%

<p>Optimal management of diabetic foot osteomyelitis: challenges and solutions</p>

Martínez¹,

Álvarez²,

Tardáguila‐García³

et al. 2019

DMSO

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Purpose: Diabetic foot osteomyelitis (DFO) is the most frequent infection associated with diabetic foot ulcers, occurs in >20% of moderate infections and 50%–60% of severe infections, and is associated with high rates of amputation. DFO represents a challenge in both diagnosis and therapy, and many consequences of its condition are related to late diagnosis, delayed referral, or ill-indicated treatment. This review aimed to analyze the current evidence on DFO management and to discuss advantages and disadvantages of different treatment options. Methods: A narrative review of the evidence was begun by searching Medline and PubMed databases for studies using the keywords “management”, “diabetic foot”, “osteomyelitis”, and “diabetic foot osteomyelitis” from 2008 to 2018. Results: We found a great variety of studies focusing on both medical and surgical therapies showing a similar rate of effectiveness and outcomes; however, the main factors in choosing one over the other seem to be associated with the presence of soft-tissue infection or ischemia and the clinical presentation of DFO. Conclusion: Further randomized controlled trials with large samples and long-term follow-up are necessary to demonstrate secondary outcomes, such as recurrence, recurrent ulceration, and reinfection associated with both medical and surgical options.

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Outcome of limited forefoot amputation with primary closure in patients with diabetes

Cited by 26 publications

References 20 publications

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

Global recurrence rates in diabetic foot ulcers: A systematic review and meta‐analysis

IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes

<p>Optimal management of diabetic foot osteomyelitis: challenges and solutions</p>

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