The aim of this work was to evaluate, via foot and ankle TC scans, the outcomes of the use of a bone substitute (CERAMENT|™G) and the growth of native bone in the treatment of osteomyelitis (OM) of the diabetic foot. In nine patients from July 2014 to December 2016 we used a Calcium Sulphate Hemihydrate + Hydroxyapatite + Gentamicin Sulfate (CSH + HA + GS) compound to fill resected bone voids following surgical intervention in OM diabetic foot cases. Of these nine patients, three were female and six were male and their ages were between 49 and 72 years. Four patients had hindfoot involvement and underwent partial calcanectomy. Two patients presented a rocker-bottom Charcot foot pattern III according to Sanders and Frykberg's classification and were treated with esostectomy of the symptomatic bony prominence of the midfoot. One patient presented OM of the 3°, 4° and 5° metatarsal bones. One patient underwent partial resection of the midfoot and hindfoot with arthrodesis stabilised by an internal-external hybrid fixator. One patient with a Charcot foot pattern IV-V underwent partial talectomy and calcanectomy with arthrodesis stabilised by an internal-external hybrid fixator. In all these patients - after removal of the infected bone - we applied 10 to 20 ml CSH + HA + GS filling the residual spaces with the aim of stabilising the remaining bone fragments. The uniqueness of this product is that it induces native bone growth, while the synthetic bone disappears and antibiotic is released into the surrounding tissues. In March 2018, the above nine patients underwent foot and ankle TC scans to evaluate bone growth.Aim
Method
Since July 2013 our group has been using an antibiotic bone substitute, composed of calcium sulphate, hydroxyapatite and gentamicin sulphate (CSH + HA + GS), in the treatment of osteomyelitis (OM) in diabetic foot. The aim of this work was to evaluate the mid-term efficacy of this treatment regime on outcomes. A favourable outcome in diabetic foot includes no recurrence of OM, healed soft tissues and the ability to weight-bear. To date we have used the CSH + HA + GS bone substitute in 24 diabetic patients with OM. In this study we reviewed patients treated from July 2013 to December 2014, in which we used CSH + HA + GS to treat OM of the forefoot, midfoot and hind foot, and evaluated how many patients are able to walk and fully weight-bear at present. We identified 11 pts treated during this time period; 1 with bilateral 1St metatarsal-head OM due to plantar ulcers, 5 with midfoot OM secondary to Charcot deformities and ulcers, 5 with hind foot OM due to pressure ulcers or Charcot deformity. We continuously monitored the patients for recurrence of OM, ulcers and soft tissue inflammation in our outpatient department.Aim
Method
Aim of this work was to evaluate the efficacy of a new antibiotic bone substitute (CERAMENTTM|G) in the treatment of osteomyelitis (OM) in diabetic foot. From June 2013 to April 2015 we used a new Calcium Sulphate Hemihydrate + Hydroxyapatite + Gentamicin Sulfate (CSH + HA + GS) compound to fill resected bone voids following surgical intervention in cases of diabetic foot OM. The uniqueness of this product is that it induces native bone growth, while the synthetic bone disappears and antibiotic is released into the surrounding tissues, maintaining high gentamicin concentrations for some weeks. In 20 patients, with or without Charcot neuroarthropathy and post-lesional osteomyelitis, after removal of infected bone we applied 10 to 20 ml CSH + HA + GS, filling the residual spaces and aiming to stabilize the remaining bone fragments. When needed, these arthrodeses were stabilized by external-internal hybrid fixators. X-ray evaluations and, when indicated, MRI evaluations were performed before and after surgical intervention, and 3 months post-op. Revascularization with percutaneous angioplasty was performed when needed. 20 patients affected by OM were treated, 4 of them having 1st metatarsal head involvement, 4 having heel involvement, 12 tarsal and hindfoot involvement. After surgical intervention all of them were treated with standard medication and pressure relief. The three 1st metatarsal OM cases healed, both in regards to infection and lesions. One of the patients is still ongoing. One of the patients with heel OM presented with a worsening of the infection and was treated by major amputation, another one presented with good soft tissue growth and, two months from the intervention, and in the absence of clinical signs of OM relapse, was treated with a sural fasciocutaneous pedicled flap; of the remaining two patients one heald and the other is still ongoing; 11 of the 12 patients who had midfoot or hindfoot partial resections healed, one patient is still ongoing. The healed patients are all wearing suitable shoes. The use of a new CSH + HA + GS bone substitute has shown to be efficacious in inducing OM healing and preserving foot structures in diabetic feet.
