TY - JOUR
T1 - Surgical treatment of diabetic foot ulcers complicated by osteomyelitis with gentamicin‐loaded calcium sulphate‐hydroxyapatite biocomposite
AU - Hutting, Kor H.
AU - aan de Stegge, Wouter B.
AU - van Netten, Jaap J.
AU - ten Cate, Wouter A.
AU - Smeets, Luuk
AU - Welten, Gijs M. J. M.
AU - Scharn, Dick M.
AU - de Vries, Jean-Paul P. M.
AU - van Baal, Jeff G.
N1 - Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/1/2
Y1 - 2021/1/2
N2 - Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin‐loaded calcium sulphate‐hydroxyapatite (CaS‐HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow‐up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin‐resistant osteomyelitis (hazard ratio (HR), 3.847; 95%‐confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%‐CI, 1.187–11.060) and surgical procedures with gentamicin‐loaded CaS‐HA biocomposite that involved minor amputations (HR, 3.965; 95%‐CI, 1.608– 9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin‐loaded CaS‐HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.
AB - Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin‐loaded calcium sulphate‐hydroxyapatite (CaS‐HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow‐up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin‐resistant osteomyelitis (hazard ratio (HR), 3.847; 95%‐confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%‐CI, 1.187–11.060) and surgical procedures with gentamicin‐loaded CaS‐HA biocomposite that involved minor amputations (HR, 3.965; 95%‐CI, 1.608– 9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin‐loaded CaS‐HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.
KW - Diabetes mellitus
KW - Foot infections
KW - Foot ulcers
KW - Gentamicin‐loaded calcium sulphate‐hydroxyapatite biocomposite
KW - Osteomyelitis
KW - Surgery
UR - http://www.scopus.com/inward/record.url?scp=85106878246&partnerID=8YFLogxK
U2 - https://doi.org/10.3390/jcm10020371
DO - https://doi.org/10.3390/jcm10020371
M3 - Article
C2 - 33478085
SN - 2077-0383
VL - 10
SP - 1
EP - 20
JO - Journal of clinical medicine
JF - Journal of clinical medicine
IS - 2
M1 - 371
ER -