Limb Salvage in Diabetic Patients With Combination of Radical Excision, Antibiotic Impregnated Bone Cement, and External Fixator Application

Abstract

In patients with diabetes, foot ulceration is a major cause of morbidity and hospitalization. The combination of deep ulcers and underlying osteomyelitis in patients with diabetes frequently leads to chronic nonhealing foot ulcers. These patients have often ended up with amputation. From 2003 to 2017, 17 of 175 diabetic patients (11 males and 6 females, 37 to 82 y old) were treated for diabetic foot and presented with complaints of ulceration, osteomyelitis, and foot gangrene. Magnetic resonance imaging–guided necrotic tissue debridement was performed, after the placement of antibiotic-impregnated bone cement, and soft tissue defect reduction was performed with an external fixator. Approximately 4 weeks later, polymethylmethacrylate was removed, and then the external fixator was removed after the soft tissue defect was closed. No patients had recurrent ulceration or osteomyelitis seen on radiographs up to their latest follow-up. There was pin tract infection in 2 patients who were treated with oral antibiotics and wound dressings. All patients have a fibrous union in the metatarsophalangeal joint. Compared with other radical techniques such as amputation, amputation, and long-term wound dressings, salvage of limbs with an external fixation can be used in selected patients who have osteomyelitis and soft tissue defects after debridement. Level of Evidence: Diagnostic level III—nonrandomized controlled cohort study.