Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis

Abstract Background Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bo...

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Main Authors: Cheng-He Qin, Chun-Hao Zhou, Hui-Juan Song, Guo-Yun Cheng, Hong-An Zhang, Jia Fang, Rui Tao
Format: Article
Language:English
Published: BMC 2019-05-01
Series:BMC Musculoskeletal Disorders
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12891-019-2635-8
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spelling doaj-d755191f26744dd7bb189a3699ae4da22020-11-25T03:21:55ZengBMCBMC Musculoskeletal Disorders1471-24742019-05-012011810.1186/s12891-019-2635-8Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitisCheng-He Qin0Chun-Hao Zhou1Hui-Juan Song2Guo-Yun Cheng3Hong-An Zhang4Jia Fang5Rui Tao6Department of Orthopaedics and Traumatology, Guangdong Second Provincial General HospitalDepartment of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical UniversityDepartment of Nursing, Nanfang Hospital, Southern Medical UniversityDepartment of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical UniversityDepartment of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical UniversityDepartment of Orthopaedics and Traumatology, Guangdong Second Provincial General HospitalDepartment of Orthopaedics and Traumatology, Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical UniversityAbstract Background Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone, for the treatment of diabetic foot osteomyelitis. Methods Between 2015 to 2017, 48 limbs (46 patients) with DFO met the criteria were included for assessment. 20 limbs (18 patients) were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin-impregnated calcium sulfate was used as an adjuvant after infected bone resection while 28 limbs (28 patients) as the control group were undergone infected bone resection only. Systemic antibiotics, postoperative wound care and offloading were continued to be applied following surgery in both groups. The time to healing, healing rate, recurrence rate and amputation rate were compared between the two groups. Results In total, 90% (18/20) limbs in the CS group as compared to 78.6% (22/28) infected limbs in the control group went to heal (P = 0.513). The Mean time to healing was 13.3 weeks in the CS group and 11.2 weeks in control group (P = 0.132). Osteomyelitis recurrence rate was 0% (0/18) in the CS group and 36.4% (8/22) in the control group (P = 0.014). Postoperative leakage in calcium sulfate group was 30.0% (6/20) with a mean duration of 8.5 weeks. Amputation rate in the control group was 7.1% (2/28) compared to 0% (0/20) in the CS group (P = 0.153). Conclusions Antibiotic-impregnated calcium sulfate as an adjuvant prevents the recurrence of DFO but cannot improve the healing rate, reduce the postoperative amputation rate or shorten the time to healing. Prolonged postoperative leakage as the most common complication can be managed with regular dressing. Level of Evidence III, Retrospective Comparative Study.http://link.springer.com/article/10.1186/s12891-019-2635-8Calcium sulfateDiabetic foot osteomyelitisSurgical treatment
collection DOAJ
language English
format Article
sources DOAJ
author Cheng-He Qin
Chun-Hao Zhou
Hui-Juan Song
Guo-Yun Cheng
Hong-An Zhang
Jia Fang
Rui Tao
spellingShingle Cheng-He Qin
Chun-Hao Zhou
Hui-Juan Song
Guo-Yun Cheng
Hong-An Zhang
Jia Fang
Rui Tao
Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
BMC Musculoskeletal Disorders
Calcium sulfate
Diabetic foot osteomyelitis
Surgical treatment
author_facet Cheng-He Qin
Chun-Hao Zhou
Hui-Juan Song
Guo-Yun Cheng
Hong-An Zhang
Jia Fang
Rui Tao
author_sort Cheng-He Qin
title Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
title_short Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
title_full Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
title_fullStr Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
title_full_unstemmed Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
title_sort infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in the treatment of diabetic forefoot osteomyelitis
publisher BMC
series BMC Musculoskeletal Disorders
issn 1471-2474
publishDate 2019-05-01
description Abstract Background Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone, for the treatment of diabetic foot osteomyelitis. Methods Between 2015 to 2017, 48 limbs (46 patients) with DFO met the criteria were included for assessment. 20 limbs (18 patients) were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin-impregnated calcium sulfate was used as an adjuvant after infected bone resection while 28 limbs (28 patients) as the control group were undergone infected bone resection only. Systemic antibiotics, postoperative wound care and offloading were continued to be applied following surgery in both groups. The time to healing, healing rate, recurrence rate and amputation rate were compared between the two groups. Results In total, 90% (18/20) limbs in the CS group as compared to 78.6% (22/28) infected limbs in the control group went to heal (P = 0.513). The Mean time to healing was 13.3 weeks in the CS group and 11.2 weeks in control group (P = 0.132). Osteomyelitis recurrence rate was 0% (0/18) in the CS group and 36.4% (8/22) in the control group (P = 0.014). Postoperative leakage in calcium sulfate group was 30.0% (6/20) with a mean duration of 8.5 weeks. Amputation rate in the control group was 7.1% (2/28) compared to 0% (0/20) in the CS group (P = 0.153). Conclusions Antibiotic-impregnated calcium sulfate as an adjuvant prevents the recurrence of DFO but cannot improve the healing rate, reduce the postoperative amputation rate or shorten the time to healing. Prolonged postoperative leakage as the most common complication can be managed with regular dressing. Level of Evidence III, Retrospective Comparative Study.
topic Calcium sulfate
Diabetic foot osteomyelitis
Surgical treatment
url http://link.springer.com/article/10.1186/s12891-019-2635-8
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