Surgery clears diabetes foot bone infection
MedWire News: Surgery is usually successful in treating osteomyelitis of the foot in patients with diabetes, suggests research showing the disease is halted in around 95% of patients.
The findings are contrary to previous results which indicated that up to 60% of surgical patients continue to have infection following surgery, say Javier Aragón-Sánchez (La Paloma Hospital, Las Palmas de Gran Canaria, Spain) and co-authors.
However, patients remain at significant risk for reulceration and further episodes of osteomyelitis after the original ulcer and surgical wound have healed, the team cautions.
The researchers reviewed data from 81 patients admitted to a diabetic foot unit for osteomyelitis surgery on the forefoot (91.3%), midfoot (4.9%) or hindfoot (3.7%) between November 2007 and May 2010. Antibiotic treatment was given for a median of 36 days.
The majority (59.3%) of patients underwent conservative procedures, 39.5% underwent minor amputation, and one (1.2%) patient required major amputation. A quarter (24.7%) of patients underwent further surgery for continuing infection.
"Patients who underwent minor and major amputations after undergoing conservative surgery should not be considered as having had a 'recurrence' because the wounds were not healed," the researchers say. "In our opinion, it would be more accurate to state that they required subsequent surgery because of persistent infection whether in bone or soft tissue."
The patients were followed up for 101.8 weeks, during which time eight patients were lost to the study. Excluding five cardiovascular in-hospital deaths, and patients lost to follow up, nine (13%) of the 69 patients died, none of who had sepsis associated with an unhealed wound.
Wound healing was achieved a median of 8 weeks after surgery, and 65 patients were followed up after this point. Of these patients, 4.6% experienced recurrence of their original infection, 43.0% developed a new ulcer a median of 46 weeks later, and 16.9% had a new episode of osteomyelitis in a different bone after a median of 66 weeks.
Discussing ulceration, the team comments: "We believe that structural changes and biomechanical alterations owing to surgery were the cause of this high rate."
Nevertheless, patients with further episodes of ulceration and osteomyelitis were treated with limb‑salvaging treatment, Aragón-Sánchez et al note in Diabetic Medicine.
By Lynda Williams