Percutaneous Partial Bone Excision in the Management of Diabetic Toe Osteomyelitis

Abstract

Background: Diabetic foot osteomyelitis affecting the toes is associated with several complications including amputation. Management is variable and include medical therapy alone or coupled with surgery. Removal of infected tissues is a common therapeutic option. However, limited source data are available. This study determines the outcome and complications of percutaneous partial bone excision (PPBE) of infected bone among diabetic patients with toe osteomyelitis. Methods: This is an uncontrolled experimental prospective study in diabetic patients who underwent PPBE of infected pieces of bone for toe osteomyelitis in the outpatient setting at a single foot clinic. All participants were followed up until the occurrence of wound healing or amputation. Results: Forty-seven patients (mean ± SD age was 62.8 ± 11.6 years) participated. Forty-four patients (93.6%) had complete healing and 3 (6.4%) required toe amputation. The mean (±SD) wound healing time was 11 (±4.6) (range, 7-22) weeks. Diabetes mellitus type 1 and younger age were significantly associated with increased risk for amputation. Conclusion: PPBE of infected toes in diabetic patients can be performed successfully and safely in the outpatient clinic. It can also improve healing and avoids inpatient stay. Level of Evidence: Level II, prospective cohort study.

Foot & Ankle

“…A study from Amman (Jordan) investigated the outcome of percutaneous partial bone excision (PPBE) of infected pieces of bones in diabetic patients in an outpatient setting to treat toe ulceration and infection as an alternative to amputation. 3 The clinic where the study took place adopted a multidisciplinary approach, with staff consisting of vascular surgeons, general surgeons, infectious disease physicians, and certified diabetic foot care nurses. All the patients who attended the diabetic foot clinic and were suffering from toe ulcers with an underlying toe osteomyelitis were included.…”