Abstract
Complex foot infections involving bone and soft tissue in patients with co-morbidities
such as diabetes and peripheral arterial disease (PAD) are a cause of significant
hospital admission. They are associated with substantial economic costs to health
services worldwide. Historically, severe foot infection has been treated with surgical
debridement and prolonged courses of systemic antibiotics. Prolonged systemic antibiotic
use increases the risk of drug side effects, antimicrobial resistance and Clostridium
difficile infection. The purpose of this study was to investigate whether surgical
debridement and implantation of antibiotic loaded calcium sulfate is effective in
the resolution of foot infection and wound healing. A retrospective cohort study of
137 consecutive cases of osteomyelitis (127) or significant soft tissue infection
(10) over 62 months from 02/2013 to 04/2018 was conducted following local ethical
approval. All cases of infection were treated with surgical debridement and local
antibiotic-loaded calcium sulfate. The primary outcomes of infection resolution, time
to healing and duration of postoperative antibiotics were measured. In 137 cases,
88.3% of infections resolved. Infection was eradicated in 22 patients without postoperative
systemic antibiotics. About 82.5% of wounds healed, with an average healing time of
11.3 weeks. Healing time was significantly increased for the co-morbidities of diabetes
and PAD (p =< .05) and for those requiring prolonged systemic postoperative antibiotics. Conservative
surgical debridement and implantation of local antibiotic impregnated calcium sulfate
is safe and effective in managing complex foot infections. We advocate early surgical
intervention before deeper tissue involvement to help preserve lower limb structure
and function.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: July 22, 2021
Footnotes
Financial Disclosure: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of Interest: None reported.
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© 2021 by the American College of Foot and Ankle Surgeons. All rights reserved.
