Treatment of Diabetic Foot Osteomyelitis: A Surgical Critique

被引:66
|
作者
Aragon-Sanchez, Javier [1 ]
机构
[1] Hosp La Paloma, Diabet Foot Unit, Dept Surg, Las Palmas Gran Canaria 35005, Canary Islands, Spain
来源
关键词
osteomyelitis; bone infection; diabetic foot; diabetic foot infection; amputation; peripheral vascular disease; PERIPHERAL VASCULAR-DISEASE; RANDOMIZED CONTROLLED-TRIAL; LOWER-EXTREMITY SALVAGE; PRESSURE WOUND THERAPY; CRITICAL LIMB ISCHEMIA; CONSERVATIVE MANAGEMENT; RETROSPECTIVE-COHORT; ANKLE AMPUTATION; RISK-FACTORS; SOFT-TISSUE;
D O I
10.1177/1534734610361949
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Osteomyelitis is one of the most frequent infections of the diabetic foot accounting for 10-15% of mild infections and almost 50% of severe infections. The definitive diagnosis of foot osteomyelitis requires obtaining bone samples for microbiological and histopathological studies. The treatment of osteomyelitis of the foot in diabetic patients continues to be debated. Until recently, most experts considered that the standard treatment for diabetic foot osteomyelitis should be the surgical removal of infected bone. Recent data suggest that antibiotic treatment can achieve an apparent remission of osteomyelitis though it is difficult to identify patients for this approach. One of the main arguments used to justify the solely antibiotic treatment of osteomyelitis is the alteration of foot biomechanics produced as a consequence of surgery. Conservative surgery combined with antibiotics is an attractive option in treating diabetic foot osteomyelitis because it may reduce the changes in the biomechanics of the foot and minimize the duration of antibiotic therapy. It is currently accepted that the combination of antibiotics with surgical removal of the infected bone may cure the majority of diabetic foot osteomyelitis. Recent literature emphasizes the role of antibiotics in the management of foot infections while little effort is dedicated to reviewing the surgical treatment of this challenging diabetic complication, apart from amputation. More research, including studies of adjunctive therapies in cases of bone infection in the feet of diabetic patients is required.
引用
收藏
页码:37 / 59
页数:23
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