Studies on bacterial agents of surgical site infection in Osogbo, South Western Nigeria

Abstract

Background: Approximately 10-15% of diabetic patients develop diabetic foot (DF), which precede 85% of the lower limb amputation (LLA). The use of hyperbaric oxygen therapy (HBOT) has been suggested to encourage ulcer healing thus reducing the risk of LLA. The objective of this study is to evaluate the efficacy of HBOT in DF and asses the risk of LLA in this group of patients. Methods&Materials:Descriptionof thecohortofpatientsdiagnosed with DF that received HBOT from 1st of January, 2010 to 31 of May of 2013 in the University Hospital Marques de Valdecilla (Santander-Spain). Results: Forty patients with an average age of 61.35 years, received 16.13 sessions of HBOT. Epidemiological characteristics of patients were: 92.5% men, 72.5% had hypertension, 57.5% were non smokers, 40% had chronic renal failure and 30% had polyneuropathy.Averagedevelopment timeof thewoundwas3.92months. Indication of HBOT was infection in 72.5% of patients (20% due to chronic osteomyelitis). Wounds were located: 22.5% in calcaneus and 17.5% in interdigital area. Revascularization treatment of the lower limb was needed in 47.5% of the patients. Granulation tissue at the beginning of HBOT was presented in 5% of patients. Wounds were closed in 8.8% patients at the first month, 35.7% at the third month, 68% at the sixthmonth and79.2% in thefirst year after treatment. 35.9% patients needed amputation, with an average of 32.5 days after HBOT. 69.4% patients did not need antibiotherapy. Associated risk factors for amputation were the presence of infection (4.527, p =0.033) and non related-DF returns to the system (10.89, p =0.001). Conclusion: Adjunctive HBOT can be valuable for treating selected cases of hypoxicDF ulcers. In our cohort, HBOTwas used as adjuvant treatment in 40 cases, most of themwith vascular injury. We observe increasing rates of granulation tissue after HBOT that persists in the first year of follow up. Risk of amputation (35.9%) is lower than shown by other series. However, it still remains high, mostly associated to the presence of infection and need of readmission to hospital. However amultidisciplinary approach and further long-term evaluation are needed to define patient selection and the role of HBOT in the treatment of DFTORS for PPS salivary gland neoplasms.