Management Of Diabetic Forefoot Osteomyelitis And Chronic Calcaneal Osteomyelitis With Antibiotic-loaded Calcium Sulfate

Infected bone resection plus adjuvant antibiotic-impregnated calcium sulfate versus infected bone resection alone in treatment of diabetic forefoot osteomyelitisBackground:Managing with diabetic foot osteomyelitis(DFO)is challenging.Even if infected bones resection and thorough debridement have been performed,diabetic forefoot osteomyelitis is still difficult to cure and has a high recurrence rate.The aim of this retrospective study is to compare the outcomes of two treatment methods,infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone,for the treatment of diabetic foot osteomyelitis.Methods:Between 2015 to 2017,48 limbs(46 patients)with DFO met the inclusion and exclusion criteria were included for assessment.20 limbs(18 patients)were included in the calcium sulfate group(the CS group)in which vancomycin and/or gentamicin-impregnated calcium sulfate was used as an adjuvant after infected bone resection while 28 limbs(28 patients)as the control group were undergone infected bone resection only.Systemic antibiotics,postoperative wound care and offloading were continued to be applied following surgery in both groups.The time to healing,healing rate,recurrence rate and amputation rate were compared between the two groups.Results:90%(18/20)limbs in calcium sulfate group as compared to 78.6%(22/28)infected limbs in control group went to heal(P=0.513).The Mean time to healing was 13.3 weeks in the CS group and 11.2 weeks in control group(P=0.132).Osteomyelitis recurrence rate was 0%(0/18)in CS group and 36.4%(8/22)in control group(P=0.014).Postoperative leakage in calcium sulfate group was 30.0%(6/20)with a mean duration of 8.5 weeks.Amputation rate in control group was 7.1%(2/28)compared to 0%(0/20)in CS group(P=0.153)Conclusions:Antibiotic-impregnated calcium sulfate as an adjuvant prevents the recurrence of DFO but cannot improve the healing rate,reduce the postoperative amputation rate or shorten the time to healing.Prolonged postoperative leakage as the most common complication can be dealt with regular dressingExtensive eggshell-like debridement technique plus antibiotic-loaded calcium sulfate for one-stage treatment of chronic calcaneal osteomyelitisBackground:Successful management of chronic calcaneal osteomyelitis is challenging.Up to now,there is still lacking of a widely accepted,simple and effective surgical method to eradicate the infection and prevent osteomyelitis from recurrence.The objective of this study was to assess the outcomes of one-stage treatment of chronic calcaneal osteomyelitis with a novel debridement technique combined with antibiotic-loaded calcium sulfate.Methods:Between 2012 to 2018,33 patients(33 limbs)with chronic calcaneal osteomyelitis were analyzed retrospectively.There were 27 males(81.8%)and 6 females(18.2%),with the average age of 44.5 years(17-67 years).According to the position,13 cases were right limb(39.4%)while the other 25 cases were on left foot(60.6%).All patients with chronic calcaneal osteomyelitis were treated with a novel debridement technique named "eggshell-like debridement" combined with antibiotics-impregnated calcium sulfate in our department.During follow up,the infection remission rate,recurrence rate and amputation rate were analyzed while the American Orthopedic Foot and Ankle Society(AOFAS)ankle and hindfoot score was adopted to evaluate the postoperative hindfoot functions.Results:In total,81.8%of patients(27/33)achieved infection remission without recurrence.In patients received osteomyelitis remission,the symptoms of pain,movement limitation,sinus,topical redness and swelling were generally eliminated,most of the patients had full,painless weight-bearing without any gait abnormalities.1 8.2%(6/33)of the patients had postoperative infection recurrence,including 2 cases before wound healing and 4 cases after wound healing.The incidence of postoperative fracture and amputation was 0%(0/33).39.4%(13/33)patients had aseptic exudation after operation,and were cured after regular dressing change.The average AOFAS ankle and hindfoot score was 88.3 points(range from 67 to 100 points),implying the foot function was mostly restored.Conclusion:Eggshell-like debridement combined with antibiotic-loaded calcium sulfate is an effective method for one-stage management of chronic calcaneal osteomyelitis.With the application of this technique,secondary autogenous bone grafts become unnecessary,surgical produces can be simplified while the foot functions are well preserved.