Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery

Category: Diabetes Introduction/Purpose: Antibiotic loaded bio composites help in eradication of infection and obliteration of dead space created by debridement in diabetic foot disease. Methods: We present early results of 54 feet in 51 patients from 2 centres in the UK, where we used local antibio...

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Main Authors: Nijil L. Vasukutty MRCSEd, Simon Mordecai, Murali Subramaniam, A Tarik, Bala Srinivasan
Format: Article
Language:English
Published: SAGE Publishing 2020-10-01
Series:Foot & Ankle Orthopaedics
Online Access:https://doi.org/10.1177/2473011420S00479
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spelling doaj-6e84f0f109ff4f02b3334ac1b447eb5e2020-11-25T04:09:05ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142020-10-01510.1177/2473011420S00479Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot SurgeryNijil L. Vasukutty MRCSEdSimon MordecaiMurali SubramaniamA TarikBala SrinivasanCategory: Diabetes Introduction/Purpose: Antibiotic loaded bio composites help in eradication of infection and obliteration of dead space created by debridement in diabetic foot disease. Methods: We present early results of 54 feet in 51 patients from 2 centres in the UK, where we used local antibiotic carrier. Of these 51 had osteomyelitis and in 3 cases we used this agent prophylactically for Charcot reconstruction. All patients were managed by a multidisciplinary team. Our protocol involved, pre op assessment, debridement, culture specific systemic antibiotics and dead space obliteration with antibiotic loaded bio composite (CERAMENT G Bone Support, Lund, Sweden). The wound was managed with negative pressure wound therapy where applicable and all patients were off loaded. Skin cover where required was undertaken by our plastic surgeons. Results: Nine patients were Cierny-Mader type 1, 7 were defined as type 2, 16 were type 3 and 19 were type 4. 26 patients were type B hosts and 25 were type A hosts. 38 patients had forefoot pathology, 7 had midfoot and 9 had hindfoot disease. 6 patients had pre-operative reperfusion procedures. At a mean follow up of 72 weeks (12-136) 44 feet were infection free and 41 patients (80%) were mobilizing full weight bearing with or without surgical footwear. 15 wounds healed by secondary intention, 3 had plastic surgical procedures and 23 had primary closure. 5 patients required revision procedures. 6 patients had below knee amputation, 2 due to significant vascular disease and 2 at patient request. Conclusion: A multidisciplinary approach and a strict protocol including augmented debridement and Cerament G are effective for treatment of chronic osteomyelitis in diabetic foot disease.https://doi.org/10.1177/2473011420S00479
collection DOAJ
language English
format Article
sources DOAJ
author Nijil L. Vasukutty MRCSEd
Simon Mordecai
Murali Subramaniam
A Tarik
Bala Srinivasan
spellingShingle Nijil L. Vasukutty MRCSEd
Simon Mordecai
Murali Subramaniam
A Tarik
Bala Srinivasan
Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
Foot & Ankle Orthopaedics
author_facet Nijil L. Vasukutty MRCSEd
Simon Mordecai
Murali Subramaniam
A Tarik
Bala Srinivasan
author_sort Nijil L. Vasukutty MRCSEd
title Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
title_short Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
title_full Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
title_fullStr Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
title_full_unstemmed Antibiotic Loaded Calcium Sulphate/Hydroxy Apatite Bio Composite in Diabetic Foot Surgery
title_sort antibiotic loaded calcium sulphate/hydroxy apatite bio composite in diabetic foot surgery
publisher SAGE Publishing
series Foot & Ankle Orthopaedics
issn 2473-0114
publishDate 2020-10-01
description Category: Diabetes Introduction/Purpose: Antibiotic loaded bio composites help in eradication of infection and obliteration of dead space created by debridement in diabetic foot disease. Methods: We present early results of 54 feet in 51 patients from 2 centres in the UK, where we used local antibiotic carrier. Of these 51 had osteomyelitis and in 3 cases we used this agent prophylactically for Charcot reconstruction. All patients were managed by a multidisciplinary team. Our protocol involved, pre op assessment, debridement, culture specific systemic antibiotics and dead space obliteration with antibiotic loaded bio composite (CERAMENT G Bone Support, Lund, Sweden). The wound was managed with negative pressure wound therapy where applicable and all patients were off loaded. Skin cover where required was undertaken by our plastic surgeons. Results: Nine patients were Cierny-Mader type 1, 7 were defined as type 2, 16 were type 3 and 19 were type 4. 26 patients were type B hosts and 25 were type A hosts. 38 patients had forefoot pathology, 7 had midfoot and 9 had hindfoot disease. 6 patients had pre-operative reperfusion procedures. At a mean follow up of 72 weeks (12-136) 44 feet were infection free and 41 patients (80%) were mobilizing full weight bearing with or without surgical footwear. 15 wounds healed by secondary intention, 3 had plastic surgical procedures and 23 had primary closure. 5 patients required revision procedures. 6 patients had below knee amputation, 2 due to significant vascular disease and 2 at patient request. Conclusion: A multidisciplinary approach and a strict protocol including augmented debridement and Cerament G are effective for treatment of chronic osteomyelitis in diabetic foot disease.
url https://doi.org/10.1177/2473011420S00479
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