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05-01-2012 | Surgery | Article

Soft tissue abscess prognosis poorer than osteomyelitis for diabetes patients


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MedWire News: Diabetes patients with soft tissue abscesses of the foot are more likely to require amputation and more likely to require amputation at the midfoot level than those with chronic osteomyelitis, demonstrate study findings published in the Journal of Foot and Ankle Surgery.

Diabetes foot disease classifications define soft tissue abscesses and chronic osteomyelitis as moderate conditions, explain Giacomo Clerici and co-workers, from the IRCCS Multimedica Hospital Sesto San Giovanni in Milan, Italy.

"On the contrary, in our clinical practice, these two clinical presentations of diabetic foot infection are two quite distinct entities, each having different treatment requirements and different prognostic implications," the researchers say.

The team followed-up 452 patients admitted to a diabetes foot unit between 2008 and 2010 due to a deep soft tissue abscess (n=210) or chronic osteomyelitis (n=242).

Patients with soft tissue abscesses underwent emergency debridement while patients with osteomyelitis underwent elective surgery.

Overall, 5.8% of patients underwent major amputation, affecting 8.6% of soft tissue and 3.3% of osteomyelitis patients.

Among the soft tissue abscess patients, 28.9% healed with drainage alone, and 70.0% underwent minor amputation at the level of the forefoot (36.1%) or midfoot (63.9%). In comparison, 96.7% of patients with chronic osteomyelitis required minor amputation at the forefoot (88.9%) or midfoot (11.1%) level.

Thus abscess patients were significantly more likely to require midfoot amputation than those with osteomyelitis.

Patients with soft tissue abscesses were also significantly more likely to experience postoperative complications than those with chronic osteomyelitis. Three patients with abscesses died after surgery from septic shock (n=1) or sudden death, whereas all osteomyelitis patients survived.

In multivariate analysis, amputation was significantly associated with abscess development (odds ratio [OR=2.6], dialysis OR=3.2), and a C-reactive protein level above 0.5 mg/dL (OR=3.8).

"The data of this study testify that the severity of a foot soft tissue abscess is not comparable with the severity of an osteomyelitis with respect to the major and minor amputation outcomes," Clerici et al conclude.

"These prognostic characteristics might be very useful for selecting the most appropriate therapeutic approach to the patient with diabetes and foot infection, and perhaps this aspect may play an important role from a medical-legal point of view."

By Lynda Williams

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