Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis

Allen, Latricia L.; Kalmar, Garrett; Driver, Vickie R.

doi:10.1053/j.tvir.2016.05.001

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…Turkey et al found that there was a positive correlation between the incidence of osteomyelitis and the arterial ischemic disease. Incidence of amputation among patients with diabetes who also have peripheral arterial disease and osteomyelitis increased signi cantly [23,24] . In previous animal osteomyelitis models, local injection of vascular sclerosing agent was used to simulate clinical ischemic symptoms.…”

Section: Discussionmentioning

confidence: 99%

Establishment of an animal model of chronic osteomyelitis with Staphylococcus aureus by ligating the femoral artery of rats

Feng

Yang

Wang

et al. 2020

Preprint

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Background Osteomyelitis caused by Staphylococcus aureus (S. aureus) is an important post-operation complication, especially after fracture internal fixation and artificial joint replacement. Animal models play an indispensable role in exploring the pathogenesis of osteomyelitis. Most models use internal fixation, bacterial suspension and vascular sclerosing agent to destroy blood vessels. Vascular sclerosing agents not only damage blood vessels but also lead to local inflammatory immune disorders, which is different from simple vascular disease and osteomyelitis caused by ischemia in clinical practice. Methods The experimental animals were randomly divided into three groups: femoral artery ligation group, vascular sclerosing agent group and non-infection aseptic operation group. In the femoral artery ligation group, the femoral artery was ligated to reduce the blood flow of the affected limb to simulate the clinical ischemic state and increase the susceptibility, then the Kirschner needle with S. aureus biofilm was implanted into the tibia of rats, and the bone defect was sealed with aseptic paraffin. The non-infection aseptic operation group and the infection model group caused by vascular sclerosing agent have been used as the blank and positive control group. After operation, survival rate, body temperature and incision healing were monitored. Four weeks later, radiological and pathological changes of all animals were evaluated, and the secretions from osteomyelitis experienced etiological separation and cultivation. Results The chronic osteomyelitis model was established successfully by ligating femoral artery and implanting Kirschner needle covered with S. aureus biofilm. Signs of chronic osteomyelitis were observed in all rats of femoral artery ligation infection group and positive control group. No signs of infection and chronic osteomyelitis were found in the non-infection aseptic operation control group. Conclusion The method of ligating the femoral artery and implanting Kirschner needle with S. aureus biofilm into the tibia of rats can effectively establish a stable and reproducible chronic osteomyelitis model which is closer to the clinical pathogenesis and natural route of infection. This model could be useful for the study of pathogenesis and therapeutics of chronic osteomyelitis with S. aureus.

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Section: Discussionmentioning

confidence: 99%

Establishment of an animal model of chronic osteomyelitis with Staphylococcus aureus by ligating the femoral artery of rats

Feng

Yang

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…If a diabetic patient has vasculopathy and neuropathy, it is easy for a wound on the extremity to develop. [ 1 ] Although such wounds occur on the foot through repeated irritation, the patient is not able to recognize it because of sensory deficits. Moreover, the unrecognized wound often becomes chronically unhealed, due to poor vascularity, which interferes with wound healing.…”

Section: Introductionmentioning

confidence: 99%

The appropriate management algorithm for diabetic foot

et al. 2018

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Background:Diabetic foot management is a challenge for reconstructive surgeons because it combines dramatically decreased circulation and chronic infection. The goal of managing this condition is to maximize viable tissue; however, unsatisfactory results, such as extremity amputation, are unavoidable in some cases. For appropriate management, thorough understanding of diabetic foot and the phased approach to its management is needed. The purpose of this study is to introduce an optimal algorithm for diabetic foot management by analyzing cases >12 years.Methods:A total of 274 patients with diabetic foot at Hanyang University Guri Hospital from 2005 to 2017 were reviewed. The management process was divided into 5 steps: patient evaluation, wound preparation, improving vascularity, surgery and dressing, and rehabilitation. Patient evaluation included a microbial culture, evaluation of vascularity, and an osteomyelitis assessment. During wound preparation, debridement and negative-pressure wound therapy were performed. Vascularity was improved by radiological intervention or surgical method. Surgery and dressing were performed depending on the indications. Rehabilitation was started after complete wound healing.Results:An infection was confirmed in 213 of 263 patients (81.0%). Of 74 cases in which a vascular study was performed, 83.8% showed arterial occlusion. When surgery was performed with complete eradication of the infection in 155 patients, the rate of revision surgery was 20.6%. The revision rate after surgery with a remnant infection of 66 patients was 40.9% (P = .0003). When surgery was performed after successful revascularization for improving blood flow of 47 patients, the rate of revision surgery was 21.3%. In contrast, the revision rate after surgery with unsuccessful or no revascularization of 174 patients was 28.2% (P = .359).Conclusion:Diabetic foot is a debilitating disease arising from multifactorial process. As its management is complex, a comprehensive but accessible treatment algorithm is needed for successful results. For this reason, the appropriate algorithm for diabetic foot management introduced in this study is significant.

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Similarities and Differences Between Diabetes-Related and Trauma-Related Calcaneal Osteomyelitis: Comparisons Based on 681 Reported Cases

Liu,

Chen,

Huang

et al. 2023

IDR

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Background Current information were still limited regarding clinical characteristics, diagnosis, and treatment efficacy of calcaneal osteomyelitis (CO). The present study summarized similarities and differences between diabetes-related CO (DRCO) and trauma-related CO (TRCO) based on synthesis analysis of literature-reported cases. Methods We searched the PubMed, Embase, and Cochrane Library databases to find English studies reporting DRCO and TRCO published between January 2000 and December 2021. Effective data were extracted and synthesized for comparisons. Results Altogether 108 studies with 278 DRCO and 403 TRCO patients were analyzed. The ratio of females among the DRCO patients was significantly higher than that of the TRCO patients (37.4% vs 24.3%, P < 0.001). The median age at diagnosis of the DRCO patients was statistically older than the TRCO patients (56 vs 44 years, P < 0.001). The median symptom duration of the DRCO patients was longer than the TRCO patients (4 vs 2 months, P = 0.136), with ulcer and sinus as the top symptoms for the DRCO and TRCO patients, respectively. The positive rate of pathogen culture for the DRCO patients was significantly higher than that for the TRCO patients (94.8% vs 69.5%, P < 0.001). The DRCO patients had higher risks of infection relapse (32.3% vs 16.3%, P < 0.001) and amputation (24.8% vs 1.4%, P < 0.001), and a higher all-cause mortality (4.9% vs 1.3%, P = 0.03) than the TRCO patients. Conclusion DRCO and TRCO shared similar and different clinical features and diagnostic issues. However, compared with TRCO, the clinical efficacy and prognosis of DRCO were worse.

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Treatment of a High-Risk Diabetic Patient with Peripheral Vascular Disease and Osteomyelitis

Cited by 3 publications

References 24 publications

Establishment of an animal model of chronic osteomyelitis with Staphylococcus aureus by ligating the femoral artery of rats

Establishment of an animal model of chronic osteomyelitis with Staphylococcus aureus by ligating the femoral artery of rats

The appropriate management algorithm for diabetic foot

Similarities and Differences Between Diabetes-Related and Trauma-Related Calcaneal Osteomyelitis: Comparisons Based on 681 Reported Cases

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