Osteomyelitis and Neuropathic Ulcers in Forefoot—Amputation Is the Only Surgical Intervention Resolving?

Background and Aim: The aim of this study is to show a simple therapeutic method in cases of neuropathic ulcer complicated by osteomyelitis in the forefoot to resolve this complication avoiding amputation. Patients-Methods: Our material consists of 28 patients (19 males, 9 females) with “diabetic foot” aged 57,31±10,25 years, mean HbA1c: 8,65±1,7%, of duration of diabetes 13,84±9,2 years and 32% of them are active smokers. NDS, VPT, ABI are measured. All of them had neuropathic ulcers located in the forefoot and 10 of them had previous amputations. The average duration of the ulcer was 1 year complicated with osteomyelitis in admission time. The diagnosis of osteomyelitis was made with MRI, RX, probe-to-bone test and verification of elevated ESR and CRP. We start with the collection of the cultures (bone sample in 6 of 28 patients) and antibiotic treatment according the cultures. After the diagnosis of osteomyelitis we proceeded to prepare a surgical field and through the ulcer we removed the infected bone-phalanx taking a bone sample for microbiological study. After we scraped and cleaned the cavity well, a 48-hour drain was placed and becomes transdermal wound suture if is a necessary. The duration of the antibiotic treatment depends from the lesion area, the results of microbiological culture and varies from 4-6 weeks to 4-6 months. Results: After practicing this technique all cases were healed at an average 40 days with an effective offload and an appropriate topical care to keep the ulcer clean and with an optional moisture. The duration of hospitalization 2-8 days depending on the severity of the infection. Conclusion: It is essential to raise other less invasive and conservative methods than amputation. Specially in those with good distal arterial perfusion that in many cases are young, the avoidance of a amputation has many benefits in their quality of life. Finally, the applied method is rapid inexpensive without disturbing the biomechanical balance of the foot to a large extent. Disclosure D. Skoutas: None. F. Sayegh: None. S. Metallidis: None. S. Sgoutzakos: None. I. Katsanos: None. S. Georga: None. A. Nikolaidis: None. L. Doukas: None. E. Matopoulou: None. S. Tesfaye: Speaker9s Bureau; Self; Pfizer Inc.. Other Relationship; Self; Janssen Pharmaceuticals, Inc., Takeda Development Centre Europe Ltd.. Advisory Panel; Self; Worwag Pharma GmbH & Co. KG. C. Manes: None. G. Tzatzagou: None.