Does Complete Resection of Infected Bone Always Result in Superior Outcomes?

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Osteomyelitis in patients with diabetes presents significant clinical challenges, often leading to prolonged treatments and complex surgical decisions. A recent study by our long-time toemigo Lavery and colleagues published in The International Wound Journal delves into whether complete resection of infected bone improves outcomes in these patients.¹

The study analyzed data from 171 patients with diabetes who underwent surgical treatment for osteomyelitis, dividing them into two groups: those with no residual osteomyelitis (NRO) after surgery and those with residual osteomyelitis (RO). Surprisingly, the study found that while patients in the NRO group experienced shorter durations of antibiotic therapy both during and after hospitalization, the overall 12-month outcomes—such as wound healing, re-infection, and hospitalization rates—did not significantly differ between the two groups.¹

Key findings from this study included:¹
• Shorter antibiotic courses: Patients with complete resection (NRO) had significantly shorter durations of antibiotic treatment (21 days vs. 37 days during hospitalization and 42 days vs. 50 days during follow-up).
• Higher amputation rates: Patients in the NRO group had higher rates of amputation during the initial hospitalization.
• Similar long-term outcomes: Both groups exhibited similar rates of wound healing, re-infection, and hospitalization over the 12-month follow-up period.

A Historic Perspective on Complete Resection of Osteomyelitis

Traditionally, the complete resection of infected bone in diabetic foot osteomyelitis has been widely regarded as an essential step in managing severe infections. This approach stems from the belief that fully removing all infected tissue—including bone—prevents the spread of infection, reduces recurrence, and promotes healing. Historically, this aggressive approach has often been paired with systemic antibiotics to ensure no residual infection remains.

This study challenges the assumption that complete resection necessarily leads to better long-term outcomes. The findings suggest that surgical decisions should consider patient preferences and the balance between resection and other therapeutic strategies, as long-term results may not be substantially impacted by complete resection alone.¹

This study by Lavery and team raises an intriguing point about the balance between aggressive surgical intervention and conservative management. Their findings could challenge the notion that total resection is universally necessary, particularly in certain patient populations. If supported by additional research, this could open the door for more nuanced surgical approaches—favoring tailored resections based on patient health, infection severity, and risk factors—allowing us to potentially reduce the physical burden of surgery and expedite recovery.

Dr. Armstrong is Professor of Surgery at the Keck School of Medicine at the University of Southern California. He is the Director of the Southwestern Academic Limb Salvage Alliance (SALSA).

This blog was adapted with permission from Dr. Armstrong and originally appeared here.

Reference
1.        Lavery LA, Tarricone AN, Reyes MC, et al. Does complete resection of infected bone improve clinical outcomes in patients with diabetic foot osteomyelitis? Int Wound J. 2024;21:e70072. DOI: 10.1111/iwj.70072.