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Successful Limb-sparing Treatment Strategy for Diabetic Foot Osteomyelitis

Alison M. Beieler Department of Medicine and Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.

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Timothy C. Jenkins Department of Medicine and Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.

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Connie S. Price Department of Medicine and Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.

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Carla C. Saveli Department of Medicine and Division of Infectious Diseases, University of Colorado Hospital, Aurora, CO.

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Merribeth Bruntz Department of Orthopaedic Surgery, Denver Health Medical Center, Denver, CO.

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Robert W. Belknap Department of Medicine and Division of Infectious Diseases, Denver Health Medical Center, Denver, CO.

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Background:

Diabetic foot osteomyelitis is common and causes substantial morbidity, including major amputations, yet the optimal treatment approach is unclear. We evaluated an approach to limb salvage that combines early surgical debridement or limited amputation with antimicrobial therapy.

Methods:

We conducted a retrospective cohort study of patients treated between May 1, 2005, and May 31, 2007. The primary end point was cure, defined as not requiring further treatment for osteomyelitis of the affected limb. The secondary end point was limb salvage, defined as not requiring a below-the-knee amputation or a more proximal amputation.

Results:

Fifty patients with diabetic foot osteomyelitis met the study criteria. Initial surgical management included local amputation in 43 patients (86%) and debridement without amputation in seven (14%). Most infections (n = 30; 60%) were polymicrobial, and Staphylococcus aureus was the most common pathogen (n = 23; 46%). Parenteral antibiotics were used in 45 patients (90%). Patients who had pathologic evidence of osteomyelitis at the surgical margin received therapy for a median of 43 days (interquartile range [IQR], 36–56 days), whereas those without evidence of residual osteomyelitis received therapy for a median of 19 days (IQR, 13–40 days). Overall, 32 patients (64%) were considered cured after a median follow-up of 26 months (IQR, 12–38 months). Fifteen of 18 patients (83%) who failed initial therapy were treated again with limb-sparing surgery. Limb salvage was achieved in 47 patients (94%), with only three patients (6%) requiring below-the-knee amputation.

Conclusions:

In patients with diabetic foot osteomyelitis, surgical debridement or limited amputation plus antimicrobial therapy is effective at achieving clinical cure and limb salvage. (J Am Podiatr Med Assoc 102(4): 273–277, 2012)

Corresponding author: Alison Beieler, PA-C, MS, 660 Bannock St, MC 4000, Denver, CO 80204. (E-mail: alisonbeieler@gmail.com)