advertising
-
1.
Blume P, Wu S: Updating the diabetic foot treatment algorithm: recommendations on treatment using advanced medicine and therapies. Wounds 30: 29, 2018.
-
2.
Sanders LJ: Diabetes mellitus: prevention of amputation. JAPMA 84: 322, 1994.
-
3.
Lipsky BA: Osteomyelitis of the foot in diabetic patients. Clin Infect Dis 25: 1318, 1997.
-
4.
Jaroenarpornwatana A, Koonalinthip N, Chawaltanpipat S, et al: Is the duration of diabetic foot ulcers an independent risk factor for developing diabetic foot osteomyelitis? Foot 56: 102000, 2023.
-
5.
Waldvogel FA, Medoff G, Swartz MN: Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med 282: 198, 1970.
-
6.
Cates NK, Wang K, Stowers JM, et al: The vertical contour calcanectomy, an alternative approach to surgical heel ulcers: a case series. J Foot Ankle Surg 58: 1067, 2019.
-
7.
Wang EH, Simpson S, Bennet GC: Osteomyelitis of the calcaneum. J Bone Joint Surg Br 74: 906, 1992.
-
8.
Antoniou D, Conner AN: Osteomyelitis of the calcaneus and talus. J Bone Joint Surg Am 56: 338, 1974.
-
9.
Babiak I, Pędzisz P, Kulig M, et al: Comparison of bone preserving and radical surgical treatment in 32 cases of calcaneal osteomyelitis. J Bone Jt Infect 1: 10, 2016.
-
10.
Elmarsafi T, Pierre AJ, Wang K, et al: The vertical contour calcanectomy: an alternative surgical technique to the conventional partial calcanectomy. J Foot Ankle Surg 58: 381, 2019.
-
11.
Cook HR, Cates NK, Kennedy CJ, et al: Risks factors associated with major lower extremity amputation after vertical contour calcanectomy. J Foot Ankle Surg 61: 1046, 2022.
-
12.
Cook H, Kennedy C, Delijani K, et al: Early clinical, functional, and mortality outcomes for heel ulcers treated with a vertical contour calcanectomy. J Foot Ankle Surg 61: 117, 2022.
-
13.
Schade VL: Partial or total calcanectomy as an alternative to below-the-knee amputation for limb salvage: a systematic review. JAPMA 102: 396, 2012.
-
14.
Pereira PF, Silva MR, Simão RS, et al: Total calcanectomy in calcaneal osteomyelitis: an alternative to major amputation. Foot 51: 101896, 2022.
-
15.
Ravine M, Kumaravel S, Dini M, et al: Outcomes of partial calcanectomy in an academic limb salvage center: a multicenter review. J Foot Ankle Surg 62: 275, 2023.
-
16.
Gauland C: Managing lower-extremity osteomyelitis locally with surgical debridement and synthetic calcium sulfate antibiotic tablets. Adv Skin Wound Care 24: 515, 2011.
-
17.
Drampalos E, Mohammad HR, Kosmidis C, et al: Single stage treatment of diabetic calcaneal osteomyelitis with an absorbable gentamicin-loaded calcium sulphate/hydroxyapatite biocomposite: the Silo technique. Foot 34: 40, 2018.
-
18.
Jiang N, Zhao X-Q, Wang L, et al: Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis. Acta Orthop 91: 353, 2020.
-
19.
Elmarsafi T, Oliver NG, Steinberg JS, et al: Long-term outcomes of permanent cement spacers in the infected foot. J Foot Ankle Surg 56: 287, 2017.
-
20.
Patil P, Singh R, Agarwal A, et al: Diabetic foot ulcers and osteomyelitis: use of biodegradable calcium sulfate beads impregnated with antibiotics for treatment of multidrug-resistant organisms. Wounds 33: 70, 2021.
-
21.
Kallala R, Harris WE, Ibrahim M, et al: Use of Stimulan absorbable calcium sulphate beads in revision lower limb arthroplasty: safety profile and complication rates. Bone Joint Res 7: 570, 2018.
-
22.
McNally MA, Ferguson JY, Scarborough M, et al: Mid- to long-term results of single-stage surgery for patients with chronic osteomyelitis using a bioabsorbable gentamicin-loaded ceramic carrier. Bone Joint J 104-B: 1095, 2022.
-
23.
Karr JC: Lower-extremity osteomyelitis treatment using calcium sulfate/hydroxyapatite bone void filler with antibiotics. JAPMA 108: 210, 2018.
-
24.
Qin C-H, Zhou C-H, Ren Y, et al: Extensive eggshell-like debridement technique plus antibiotic-loaded calcium sulphate for one-stage treatment of chronic calcaneal osteomyelitis. Foot Ankle Surg 26: 644, 2020.
-
25.
Xu L, Yu B, Hu Y-J, et al: Eggshell-like debridement and calcaneal reconstruction for managing recurrent calcaneal osteomyelitis concomitant with foot deformity: a case report. Int J Clin Exp Med 9: 23707, 2016.
-
26.
Lew DP, Waldvogel FA: Osteomyelitis. N Engl J Med 336: 999, 1997.
Vacuum-Assisted Eggshell-Type Bone Debridement with Implantation of Antibiotic-Impregnated Bone Substitute for Treatment of Calcaneal Osteomyelitis with Subsequent Charcot’s Reconstruction: A Case Report
Search for other papers by Grant Yonemoto in
Current site
Google Scholar
PubMed
Search for other papers by Timothy P. Cheung in
Current site
Google Scholar
PubMed
Search for other papers by Steven D. Vyce in
Current site
Google Scholar
PubMed
Search for other papers by Michael I. Gazes in
Current site
Google Scholar
PubMed
Charcot’s neuroarthropathy complicated by calcaneal osteomyelitis can be difficult to treat. Various surgical techniques describe how to manage these conditions. Eggshell-type debridement with application of antibiotic-impregnated bone substitute is a viable option that eliminates infected bone and allows staged reconstructive surgery. A 50-year-old woman with right midfoot Charcot’s neuroarthropathy presented with osteomyelitis of the cuboid and fourth and fifth metatarsal bases after resection and failed antibiotic therapy. The patient eventually developed adductovarus, septic shock, and hematogenous osteomyelitis of the calcaneus, navicular, and lateral cuneiform. Vacuum-assisted eggshell-type debridement was performed, and the calcaneal defect was filled with antibiotic-impregnated calcium sulfate and calcium phosphate. Eight weeks after the initial surgery, the infection resolved; however, the patient had trouble walking. She underwent staged Charcot’s reconstructive surgery with application of a dynamic multiplanar external fixator with gradual deformity and split-thickness skin graft to cover the residual plantar lateral foot wound. The second stage included septic fusion of the midfoot and subtalar joint from the frame. Twelve weeks postoperatively, radiographic union was achieved, the external fixator was removed, and the patient demonstrated a plantigrade foot. She was transitioned to a total-contact cast and allowed to bear weight as tolerated. Eighteen months after the initial procedure, the patient is wound-free and weightbearing in a CROW boot. This innovative eggshell-type debridement technique aspirates osteomyelitic cancellous bone while preserving cortical bone. It can be particularly useful in hematogenous osteomyelitis, where cortical integrity is not breached, or in situations where there is minimal cortical involvement. Specifically preserving the calcaneus, a major weightbearing bone, permits subsequent reconstructive surgical planning. At 18 months, there were no signs of osteomyelitis recurrence.
advertising
