Abstract
The purpose of this study was to determine the rate of residual osteomyelitis after
different foot amputations in diabetic patients with a standardized method of determining
a clean bone margin. This retrospective observational pilot study evaluated 27 diabetic
patients who had a forefoot amputation (toe, partial ray, or transmetatarsal) for
osteomyelitis at our institution from January 1, 2010, to August 1, 2011. A standardized
method was used intraoperatively to determine if bone margins were negative for residual
osteomyelitis. Short-term outcomes were assessed. Negative outcomes included wound
dehiscence, re-ulceration, re-amputation, or death. The overall rate of residual osteomyelitis
was 40.7% (11/27 patients). Patients who underwent toe amputation with joint disarticulation
had a positive margin culture rate of 23.1% (3/13). Patients who underwent partial
metatarsal or transmetatarsal amputation had a positive margin culture rate of 57.1%
(8/14). Although twice as frequent, this was not considered to be statistically significant
(p = .1201). Overall, 48.1% (13/27) of patients were considered to have poor outcomes,
and 9/11 (81.8%) patients with a positive bone margin had poor outcomes, whereas only
4/16 (25%) patients with a negative bone margin had poor outcomes. This difference
was considered statistically significant (p = .0063). Although this is a pilot study, our results do confirm the high incidence
of residual osteomyelitis with associated poor outcomes. Based on our data, we recommend
routine standardized bone margin culture after thorough debridement and irrigation.
Level of Clinical Evidence
Keywords
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References
- Major lower extremity amputation: outcome of a modern series.Arch Surg. 2004; 139: 395-399
- Risk of reamputation in diabetic patients stratified by limb and level of amputation: a 10-year observation.Diabetes Care. 2006; 29: 566-570
- The effect of residual osteomyelitis at the resection margin in patients with surgically treated diabetic foot infection.J Foot Ankle Surg. 2012; 50: 171-175
- Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey.Am J Kidney Dis. 2003; 41: 1-12
- The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis.J Bone Joint Surg Am. 2005; 87: 2464-2471
- The dysvascular foot: a system for diagnosis and treatment.Foot Ankle. 1981; 2: 64-122
- Osteomyelitis debridement techniques.Clin Orthop Relat Res. 1999; 360: 87-96
- Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival.J Bone Joint Surg Br. 2001; 83: 403-407
- A report from the international consensus on diagnosing and treating the infected diabetic foot.Diabetes Metab Res Rev. 2004; 20: S68-S77
- Histology versus microbiology for accuracy in identification of osteomyelitis in the diabetic foot.J Foot Ankle Surg. 2011; 50: 197-200
- Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures.Clin Infect Dis. 2006; 42: 57-62
- Adsorption and release of antibiotics from morselized cancellous bone. In vitro studies of 8 antibiotics.Acta Orthop Scand. 1999; 70: 298-304
- Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis.Clin Microbiol Infect. 2011; 17: 285-291
Article info
Publication history
Published online: July 23, 2012
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
