Controversies regarding radiological changes and variables predicting amputation in a surgical series of diabetic foot osteomyelitis.

BACKGROUND: To investigate if radiological changes have any influence on the outcomes of surgical treatment of diabetic foot osteomyelitis. METHODS: Data of patients included in a prospective cohort who underwent surgical treatment for definitive osteomyelitis were analyzed. Cases were classified according to radiological changes as "early osteomyelitis" when no radiological changes were found or in cases showing periosteal elevation and/or subcortical demineralization and/or cortical disruption. Cases showing sequestra and/or gross bone destruction were classified as "advanced osteomyelitis". RESULTS: Early osteomyelitis was defined according to radiological findings in 37 cases (45.7%) and advanced in 44 (54.3%). Advanced osteomyelitis was not associated with the risk of undergoing amputation. CONCLUSIONS: The bone changes seen in simple X-rays in cases of osteomyelitis do not have any prognostic value when surgical treatment is undertaken. The outcomes are more related to soft tissue involvement than bone destruction seen in simple X-rays.

Never amputate a patient with diabetes without consulting with a specialized unit.

This study presents a case report of a patient who underwent a severe infection following revascularization because dry necrosis became infected. A major amputation had been indicated because the infection did not respond to antibiotics and advanced wound care with topical negative pressure wound therapy with silver. The patient did not accept the major amputation and attended the authors' specialized unit. Persistent osteomyelitis was diagnosed with a simple X-ray, a cheap tool. Local surgery, antibiotics, appropriate wound care, and split-skin grafting achieved limb salvage in 12 weeks in this patient who had been scheduled for major amputation. Major amputation in patients with an infected foot can sometimes be avoided by correct diagnosis of infection and managing appropriately with specialized support.

Surgical treatment of limb- and life-threatening infections in the feet of patients with diabetes and at least one palpable pedal pulse: successes and lessons learnt.

Outcomes of surgically treated limb- and life-threatening infections in patients with diabetes and a well-vascularized foot based only on the palpation of foot pulses are not well known. The authors retrospectively studied a series of 173 patients with diabetes and limb- (moderate) or life- (severe) threatening infections with at least one palpable pedal pulse who were admitted to their department for the treatment of infected diabetic foot from January 1, 1998, to December 31, 2009. A total of 141 patients (81.5%) presented with limb-threatening/moderate infections and 32 (18.5%) with life-threatening/severe infections. In all, 49 patients (28.3%) presented with soft tissue infections only, 90 (52%) with osteomyelitis and 34 (19.7%) with a combined infection. Amputation was needed in 74 patients (42.7%), of whom 6 needed a major amputation (3.5% of overall). A total of 99 (57.2%) patients were treated by conservative surgery. Four patients (2.3%) died during the postoperative period (30 days). Limb salvage was achieved in 167 (96.5%) of the patients who were followed up until healing. Healing of the wounds by secondary intention was achieved in a median of 72 days. Clinical results permit the observation that a high rate of limb salvage can be achieved after the surgical treatment of limb- and life-threatening infections in patients with at least one palpable pedal pulse.