Comparing Medical vs. Surgical Management of Osteomyelitis in the Diabetic Foot

A poster to be presented at the Symposium on Advanced Wound Care (SAWC) Fall next week in Las Vegas evaluated the clinical outcomes in the published literature on medical and surgical management of diabetic foot osteomyelitis (DFO).¹
 
The meta-analysis included 28 articles—18 related to the medical management of DFO, 13 articles related to surgical management, and 3 articles focusing on a combination of medical and surgical management.
 
Poster co-author David H. Truong, DPM, MS, notes that the treatment success rate for medical management of osteomyelitis is between 30–70%. He says the wide range could be dependent on a variety of factors, such as perfusion, extent of bone infection, amount of bone destruction, uncontrolled Hg A1c, dialysis, malnourishment, smoking, and other factors.
 
“I would generally recommend medical management in two scenarios: the location of OM is not amendable to resection; and the extent of bone infection is mild,” advises Dr. Truong, who is affiliated with the Department of Orthopaedic Surgery at the University of Texas Southwestern Medical Center in Dallas.
 
Dr. Truong notes a combination of medical and surgical management for osteomyelitis would be ideal as surgical resection of the infected bone will remove the bulk of the infection. He notes this leaves behind smaller area if osteomyelitis, and the success rate of medical management of osteomyelitis would “increase dramatically.”
 
Dr. Truong suggests further research is necessary to standardize the definition of successful treatment of osteomyelitis. He notes all the studies in the meta-analysis included have different criteria to determine treatment success, while the Infectious Diseases Society of America and the International Working Group on the Diabetic Foot also do not have a clear definition of successful treatment.
 
“This makes evaluating and comparing research difficult,” says Dr. Truong.
 
A challenging first step, says Dr. Truong, would be to find a standardized treatment success criteria for management of osteomyelitis. Moreover, he notes the duration of antibiotics for managing osteomyelitis also varies widely, ranging from a couple of weeks to a year. “Inconsistency in duration of antibiotics and successful treatment criteria made evaluating the current literature difficult,” says Dr. Truong.

Reference
 
1. Truong DH, Wukich DK, LaFontaine J, Lavery LA. Meta-analysis: outcomes of surgical vs medical management of diabetic foot osteomyelitis. Presented at Symposium on Advanced Wound Care (SAWC) Fall, Las Vegas, NV, October 14–16, 2022.