Surgical techniques for Bone Biopsy in Diabetic Foot Infection, and association between results and treatment duration.

Eric Senneville,Donatienne Joulie,Nicolas Blondiaux,Olivier Robineau

doi:10.7150/jbji.45338

Eric Senneville, Donatienne Joulie + Show 2 more

Open Access

https://doi.org/10.7150/jbji.45338

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Abstract

Surgery is an important part of the management of patients diagnosed with DFO. It consists in some selected patients, to remove all or part of the infected bone(s) or even to amputate all or part of the foot. Despite the use of sophisticated imaging techniques, it is however difficult to remove all the infected tissue while respecting the principles of an economical surgery. Bone biopsy performed at the margins of the resection permits to identify residual osteomyelitis and to adjust the post-surgical antibiotic treatment. Some recent studies have reported the way to perform bone margin biopsies and have assessed the impact of the bone results on the patient's outcome. However, the real impact of a residual osteomyelitis on the risk of recurrent DFO is still debated and questions regarding the interpretation of the results remain to be solved. Similarly, the consequences in terms of choice and duration of the antimicrobial treatment to use in case of positive bone margin are not clearly established.

Highlights

Osteoarticular infections occur in 20 to 60% of diabetic foot infections and profoundly worsen the outcome of the patients [1]
It is unlikely that the duration of the antibiotic treatment required for an osteomyelitis of the foot that has been operated with partial resection or even amputation should be as long as it is for patients treated non-surgically
Most but not all the studies have reported a negative effect of residual osteomyelitis on the outcome of patients operated for diabetic foot osteomyelitis (DFO)

Summary

Introduction

Osteoarticular infections occur in 20 to 60% of diabetic foot infections and profoundly worsen the outcome of the patients [1]. Bone biopsy performed at the margins of the resection permits to identify residual osteomyelitis and to adjust the post-surgical antibiotic treatment. Surgical removal of the entire infected bone has been considered in the past and even recently as the standard treatment [2] in patients with DFO because of the poor results obtained by antibiotics alone in these settings.

Results

Conclusion