Conservative Management Of Diabetic Foot Ulcers Complicated By Osteomyelitis

Description: Conservative Management of Diabetic Foot Ulcers Complicated by Osteomyelitis from Wounds 2002 NG Yadlapalli, MD, Anand Vaishnav, MD, and Peter Sheehan, MD Abstract Osteomyelitis of the diabetic foot remains a difficult clinical infection, often resulting in disability and amputation. Standard management consists of thorough removal of all infected bone in conjunction with antimicrobial therapy. This may have an untoward effect on foot mechanics and may increase risk of future ulcer events. In order to evaluate the efficacy of a more conservative approach, we retrospectively assessed the outcomes patients managed by an interdisciplinary team of comprehensive inpatient and outpatient care. Over a three-year period, 160 patients were identified by a discharge database with osteomyelitis; of these, 58 had outpatient follow-up records for at least 12 months. The treatment regimen consisted of conservative debridement or surgery, four to six weeks of empiric intravenous antibiotics, and biomechanical offloading of pressure impediments to wound healing. Initial procedures were debridement (34 patients), excision of bone (13 patients), toe or ray amputation (8 patients), and major amputation (3 patients). The mean duration of antibiotic therapy was 40.3 days. At twelve-months follow up, twelve patients (20.7%) failed treatment, with nine patients having persistent ulcers, and three patients requiring amputation. The remaining 46 patients healed (79.3%). Three patients had ulcer recurrence and 21 patients had new ulcer episodes in the follow-up observation period. In conclusion, an approach to osteomyelitis in the diabetic foot that is based on conservative surgical intervention, long-term empiric antibiotics, and interdisciplinary wound care and offloading may be a safe and effective alternative to amputation in selected patients.