Surgical treatment of osteomyelitis in patients with diabetic foot: clinical experience
https://doi.org/10.5922/2223-2427-2024-9-3-4
Abstract
Aim. To analyse the results of surgical treatment of osteomyelitis in patients with diabetic foot.
Methods. A retrospective analytical study was conducted to assess the outcomes of surgical treatment for osteomyelitis in diabetic foot patients. The study analysed 28 patients with osteomyelitis classified as Grade III according to the Wagner classification. The average age of the participants was 62.5 ± 14.5 years, and the mean duration of diabetes mellitus was 8.2 ± 5.5 years. The cohort consisted of 16 men (67.1 %) and 12 women (32.9 %). All patients presented with a single osteomyelitic lesion located in the anterior region of the foot. The underlying causes of osteomyelitis included trophic ulcers and complications such as abscesses of the toes and phlegmon of the foot, which developed secondary to the trophic ulcers.
Results. In the group of patients who underwent both autopsy and drainage of abscesses and phlegmon, followed by one-stage amputation of one or more toes with radical resection of the corresponding metatarsal heads, the average number of hospital bed days was 31.9 ± 15.7. In contrast, the group of patients who were admitted without purulent necrotic complications and underwent one-stage amputation of one or more toes with radical resection of the metatarsal heads had an average of 13.4 ± 2.1 bed days.
Conclusion. Prolongation of medical treatment in patients with osteomyelitis of the diabetic foot, leading to the occurrence of purulent-necrotic complications, doubles the length of hospital stay, which entails an increase in treatment costs.
About the Authors
Yu. G. Lutsenko
M. Gorky Donetsk State Medical University
Russian Federation
Russian Federation
Yuri G. Lutsenko, Associate Professor
16, Ilyicha Ave., Donetsk, 283003
I. S. Karabak
Central City Clinical Hospital № 9 of Donetsk
Russian Federation
Russian Federation
Igor S. Karabak, Surgeon
1, Yelnitskaya St., Donetsk, 283030
K. S. Karabak
M. Gorky Donetsk State Medical University
Russian Federation
Russian Federation
Kirill S. Karabak, Student
16, Ilyicha Ave., Donetsk, 283003
References
1. Raspovic KM, Wukich DK. Self-reported quality of life and diabetic foot infections. J Foot Ankle Res. 2018;11:53. https://doi.org/10.1186/s13047-018-0297-7
2. Kerr M, Barron E, Chadwick P, Evans T, Kong WM, Rayman G, Sutton-Smith M, Todd G, Young B, Jeffcoate WJ. The cost of diabetic foot ulcers and amputations to the National Health Service in England. Diabet Med. 2019 Aug;36(8):995—1002. https://doi.org/10.1111/dme.13973
3. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2017 Mar;49(2):106—116. https://doi.org/10.1080/07853890.2016.1231932
4. Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M, Embil JM, Kono S, Lavery LA, Malone M, van Asten SA, Urbančič-Rovan V, Peters EJG; International Working Group on the Diabetic Foot (IWGDF). Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev. 2020;36(S1). https://doi.org/10.1002/dmrr.3280
5. Uçkay I, Aragon-Sanchez J, Lew D, Lipsky BA. Diabetic foot infections: what have we learned in the last 30 years? Int J Infect Dis. 2020;92:1—6. https://doi.org/10.1016/j.ijid.2019.11.021
6. Privolnev VV, Zabrosaev VS, Danilenko NV. Recommendations for the diagnosis and treatment of osteomyelitis in diabetic foot syndrome (review). Bulletin of the Smolensk State Medical Academy, 2014;13(3):56—59 (in Russ.).
7. Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ; International Working Group on the Diabetic Foot. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):154—168. https://doi.org/10.1002/dmrr.2703
8. Dmitriyenko AA, Anichkin VV, Kurek MF, Vaqar A. Diagnosis of osteomyelitis in diabetic foot syndrome. Health and Ecology Issues. 2014;(3):62—67 (in Russ.). https://doi.org/10.51523/2708-6011.2014-11-3-11
9. Lazaro-Martinez JL, Aragon-Sanchez J, Garcia-Morales E. Antibiotics versus conservative surgery for treating diabetic foot osteomyelitis: a randomized comparative trial. Diabetes Care. 2014;37:789—795. https://doi.org/10.2337/dc13-1526
10. Lipsky BA. Treating Diabetic Foot Osteomyelitis Primarily With Surgery or Antibiotics: Have We Answered the Question? Diabetes Care 2014;37:593—595. https://doi.org/10.2337/dc13-2510
11. Kalantar MA, Ansari M. Comparison of Metatarsal Head Resection Versus Conservative Care in Treatment of Neuropathic Diabetic Foot Ulcers. J Foot Ankle Surg. 2017 May-Jun;56(3):428—433. https://doi.org/10.1053/j.jfas.2016.11.019
12. Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton LJ, Huddleston PM. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97(10):837— 845. https://doi.org/10.2106/JBJS.N.01350
13. Tanwar YS, Ferreira N. The role of bioactive glass in the management of chronic osteomyelitis: a systematic review of literature and current evidence. Infect Dis (Lond). 2020 Apr;52(4):219—226. https://doi.org/10.1080/23744235.2019.1695059
14. Kislyakov VA, Obolensky VN, Yusupov IA. Diabetic foot syndrome: an integrated approach to treatment. RMJ. 2015;12:768—770 (in Russ.).
15. Dedov II, Tokmakova AYu, Egorova DN, Galstyan GR. Clinical recommendations for the diagnosis and treatment of diabetic foot syndrome. M., 2015 (in Russ.).
16. Aragón-Sánchez J, Cabrera-Galván JJ, Quintana-Marrero Y, Hernández-Herrero MJ, López-Valverde ME, Mónica Lázaro-Martínez J. Conservative surgery of diabetic forefoot osteomyelitis: how can I operate on this patient without amputation? Int J Low Extrem Wounds. 2019;18(1):68—74. https://doi.org/10.1177/1534734619826262
17. Tardáguila-García A, Sanz-Corbalán I, García-Alamino JM, Ahluwalia R, Uccioli L, Lázaro-Martínez JL. Medical Versus Surgical Treatment for the Management of Diabetic Foot Osteomyelitis: A Systematic Review. J Clin Med. 2021 Mar 17;10(6):1237. https://doi.org/10.3390/jcm10061237
18. Lázaro-Martínez JL, García-Madrid M, García-Álvarez Y, Álvaro-Afonso FJ, Sanz-Corbalán I, García-Morales E. Conservative surgery for chronic diabetic foot osteomyelitis: Procedures and recommendations. J Clin Orthop Trauma. 2020 Dec 15;16:86—98. https://doi.org/10.1016/j.jcot.2020.12.014
Review
For citations:
Lutsenko Yu.G., Karabak I.S., Karabak K.S. Surgical treatment of osteomyelitis in patients with diabetic foot: clinical experience. Surgical practice (Russia). 2024;(3):40-46. (In Russ.) https://doi.org/10.5922/2223-2427-2024-9-3-4
Views:
205
Email this article 
