Outcomes of surgical treatment of diabetic foot osteomyelitis: a series of 185 patients with histopathological confirmation of bone involvement

Abstract

Aims/hypothesis We analysed the factors that determine the outcomes of surgical treatment of osteomyelitis of the foot in diabetic patients given early surgical treatment within 12 h of admission and treated with prioritisation of footsparing surgery and avoidance of amputation. Methods A consecutive series of 185 diabetic patients with foot osteomyelitis and histopathological confirmation of bone involvement were followed until healing, amputation or death. Results Probing to bone was positive in 175 cases (94.5%) and radiological signs of osteomyelitis were found in 157 cases (84.8%). Staphylococcus aureus was the organism isolated in the majority of cultures (51.3%), and in 35 cases (36.8%) it proved to be methicillin-resistant. The surgical treatment performed included 91 conservative surgical procedures, which were defined as those where no amputation of any part of the foot was undertaken (49.1%). A total of 94 patients received some degree of amputation, consisting of 79 foot-level (minor) amputations (42.4%) and 15 major amputations (8%). Five patients died during the perioperative period (2.7%). Histopathological analysis revealed 94 cases (50.8%) of acute osteomyelitis, 43 cases (23.2%) of chronic osteomyelitis, 45 cases (24.3%) of acute exacerbation of chronic osteomyelitis and three remaining cases (1.6%) designated as 'other'. The risks of failure in the case of conservative surgery were exposed bone, the presence of ischaemia and necrotising soft tissue infection. Conclusions/interpretation Conservative surgery without local or high-level amputation is successful in almost half of the cases of diabetic foot osteomyelitis. Prospective trials should be undertaken to determine the relative roles of conservative surgery versus other approaches.

Antibiotics Versus Conservative Surgery for Treating Diabetic Foot Osteomyelitis: A Randomized Comparative Trial

“…Regarding the SG, the healing rates and time to healing are similar to previous reports (11,12). However, patients included in the present series differ from those in other studies for the following several reasons: only patients with forefoot osteomyelitis without necrosis, ischemia, or soft tissue infections were included.…”

“…However, patients included in the present series differ from those in other studies for the following several reasons: only patients with forefoot osteomyelitis without necrosis, ischemia, or soft tissue infections were included. It should be noted that it is precisely these factors that are related to the failure of conservative surgery and the need for amputation, and that increased the time to healing in previous studies (12,13).…”

“…We used the outcome definitions given below, based on our previous experience (12). Primary healing was defined in the AG as healing achieved exclusively with antibiotic treatment.…”

“…Several authors have reported the efficacy of surgical treatment of osteomyelitis (11)(12)(13)(14)(15). Furthermore, the development of conservative surgery to remove the bone infection while avoiding amputation is an attractive option (9,12,14).…”

“…Several authors have reported the efficacy of surgical treatment of osteomyelitis (11)(12)(13)(14)(15). Furthermore, the development of conservative surgery to remove the bone infection while avoiding amputation is an attractive option (9,12,14). However, surgery, including conservative procedures, leads to biomechanical changes and reulceration due to pressure transfer syndrome (16), even though removing a bone deformity could have a prophylactic effect (9).…”