Surgical Management of Diabetic Foot Infections and Osteomyelitis

Frykberg, Robert G.; Wittmayer, Brian C.; Zgonis, Thomas

doi:10.1016/j.cpm.2007.04.001

Cited by 80 publications

(73 citation statements)

References 51 publications

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“…Like other authors, our group believes that osteomyelitis of the diabetic foot is, once diagnosed, predominantly a surgical disease [15,16]. However, surgical treatment in one of this series [15] involved major amputations in nearly 25% of cases.…”

Section: Discussionmentioning

confidence: 53%

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

et al. 2008

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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.

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Section: Discussionmentioning

confidence: 53%

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

et al. 2008

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“…All but the simplest infections may require staged procedures; thus, the initial skin incision and dissection should take into account future surgical plans. 13 Grodinsky identified three major plantar spaces: the medial, central (superficial and deep), and lateral spaces. He recommended a medial surgical approach due to potential discomfort of a plantar incision.…”

Section: A Stepwise Surgical Approach To Management Of Diabetic Foot mentioning

confidence: 99%

A step-wise approach for surgical management of diabetic foot infections

Fisher

Scimeca

Bharara

et al. 2010

Journal of Vascular Surgery

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Diabetic foot disease frequently leads to substantial long-term complications, imposing a huge socioeconomic burden on available resources and health care systems. Peripheral neuropathy, repetitive trauma, and peripheral vascular disease are common underlying pathways that lead to skin breakdown, often setting the stage for limb-threatening infection. Individuals with diabetes presenting with foot infection warrant optimal surgical management to effect limb salvage and prevent amputation; aggressive short-term and meticulous long-term care plans are required. In addition, the initial surgical intervention or series of interventions must be coupled with appropriate systemic metabolic management as part of an integrated, multidisciplinary team. Such teams typically include multiple medical, surgical, and nursing specialties across a variety of public and private health care systems. This article presents a stepwise approach to the diagnosis and treatment of diabetic foot infections with special emphasis on the appropriate use of surgical interventions and includes the following key elements: incision, wound investigation, debridement, wound irrigation and lavage, and definitive wound closure.

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“…Over 50% of these ulcerations will become infected, resulting in high rates of hospitalization, increased morbidity and potential lower extremity amputation. Diabetic foot infections (DFI) are one of the most common diabetes related cause of hospitalization in the United States, accounting for 20% of all hospital admissions (3). Readmission rates for DFI patients are approximately 40% and nearly one in six patients die within 1 year of their infection (4).…”

mentioning

confidence: 99%

Diabetic foot infections: current concept review

Hobizal

Wukich

2012

Diabetic Foot & Ankle

170

122

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The purpose of this manuscript is to provide a current concept review on the diagnosis and management of diabetic foot infections which are among the most serious and frequent complications encountered in patients with diabetes mellitus. A literature review on diabetic foot infections with emphasis on pathophysiology, identifiable risk factors, evaluation including physical examination, laboratory values, treatment strategies and assessing the severity of infection has been performed in detail. Diabetic foot infections are associated with high morbidity and risk factors for failure of treatment and classification systems are also described. Most diabetic foot infections begin with a wound and once an infection occurs, the risk of hospitalization and amputation increases dramatically. Early identification of infection and prompt treatment may optimize the patient's outcome and provide limb salvage.

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Surgical Management of Diabetic Foot Infections and Osteomyelitis

Cited by 80 publications

References 51 publications

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

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

A step-wise approach for surgical management of diabetic foot infections

Diabetic foot infections: current concept review

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