Diabetes, Metabolic Syndrome and Obesity (Jun 2020)
Limb Salvage and Prevention of Ulcer Recurrence in a Chronic Refractory Diabetic Foot Osteomyelitis
Abstract
Xiaoyan Jiang,1,* Ning Li,1,* Yi Yuan,1 Cheng Yang,1 Yan Chen,1 Yu Ma,1 Jianbai Wang,2 Dingyuan Du,2 Johnson Boey,3 David G Armstrong,4 Wuquan Deng1 1Department of Endocrinology and Nephrology, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, People’s Republic of China; 2Department of Traumatology, Diabetic Foot Center, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing, People’s Republic of China; 3Department of Podiatry, National University Hospital, Singapore; 4Keck School of Medicine of University of Southern California, Los Angeles, CA, USA*These authors contributed equally to this workCorrespondence: Wuquan DengDepartment of Endocrinology and Nephrology, Chongqing University Central Hospital, Chongqing Emergency Medical Center, No. 1 Jiankang Road, Chongqing 400014, People’s Republic of ChinaTel +86 23 63692186Email [email protected]: Biomechanical changes caused by structural foot deformities predispose patients to plantar ulceration. Plantar ulcer recurrence often leads to osteomyelitis, which is more commonly observed in patients with diabetes. Once the infection of diabetic foot ulcer (DFU) spreads and is complicated by osteomyelitis, treatment becomes more complicated and difficult. Osteomyelitis treatment remains challenging because of low drug concentration within the tissue caused by poor circulation and inadequate localized nutrition. Moreover, tissues around plantar ulcers are fewer and are thin, making the formation of granulation tissues difficult due to elevated plantar pressure. Furthermore, the skin around the wound is excessively keratinized, and the epidermis is hard to regenerate. Meanwhile, skin grafting at that site is often not successful due to poor blood circulation. Therefore, it is technically challenging to manage diabetic pressure plantar ulcer with osteomyelitis and prevent its recurrence. Here, we present a case of chronic DFU complicated by osteomyelitis due to foot deformity. The ulcer was successfully healed using advanced wound repair technology comprising of surgical bone resection, vancomycin-loaded bone cement implant, negative-pressure wound therapy, and autologous platelet-rich gel. Subsequently, preventive foot care with custom-made offloading footwear was prescribed. The plantar ulcer did not recur and improvement in biomechanical parameters was observed after the intervention. This case represents an effective and comprehensive management strategy for limb salvage and prevention in patients with complicated foot conditions.Keywords: diabetic foot ulcer, osteomyelitis, antibiotic-loaded bone cement, autologous platelet-rich gel, negative-pressure wound therapy, offloading footwear
