The Osteomyelitis Controversy in the Diabetic Foot Ulcer

Introduction: Osteomyelitis, or infection of the bone, is often seen in association with the diabetic foot ulcer. It should be considered a surgical disease.Methods:Our treatment approach for localized osteomyelitis involving the diabetic foot is wide, extensive soft tissue debridement, performed along with bone debridement of the affected cortex and underlying cancellous bone, utilizing a rongeur and bone curette. Cancellous bone is debrided until bleeding is noted. The debrided bone is sent to pathology. Hemostasis is accomplished with bone wax. The wound is then covered with a foam dressing to achieve moist wound care. A pathology report of the initial bone debridement specimen confirms the diagnosis of acute and/or chronic osteomyelitis. A second bone specimen can be taken to insure that all of the infected bone can has been removed.Results:If all of the affected bone is removed, granulation tissue begins to form over the resected cancellous bone. When healthy appearing granulation tissue is fully established and there is no further bone visible, an advanced tissue product, such as Epifix, can be utilized. No antibiotics are used in this treatment protocol, and we have achieved complete healing in multiple cases.Discussion: With this approach, prolonged hospitalization and the use of long-term antibiotics and PICC lines are avoided. As we are dealing with biofilm involving soft tissue, periosteum, and bone, surgical debridement is the procedure of choice, and antibiotics have little to no part in our treatment.References: