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Evaluation of adjuvant antibiotic loaded injectable bio-composite material in diabetic foot osteomyelitis and Charcot foot reconstruction

Evaluation of adjuvant antibiotic loaded injectable bio-composite material in diabetic foot osteomyelitis and Charcot foot reconstruction
Evaluation of adjuvant antibiotic loaded injectable bio-composite material in diabetic foot osteomyelitis and Charcot foot reconstruction
The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27–83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8–45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12–98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4–42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.
2077-0383
Kavarthapu, Venu
304997cd-bd62-4ea8-a24d-d17ee3c74ac7
Giddie, Jasdeep
c4237a12-4a33-4ccd-96d0-fbeec1aeb208
Kommalapati, Varun
1059971e-4213-425b-988a-aa056b4b82ea
Casey, Joanne
0f6e606c-288f-443d-9bdb-6af68580b902
Bates, Maureen
8c28bf06-b37c-412a-a6af-a37c075a4776
Vas, Prashanth
57296e9a-b307-4e50-a316-06992981c587
Kavarthapu, Venu
304997cd-bd62-4ea8-a24d-d17ee3c74ac7
Giddie, Jasdeep
c4237a12-4a33-4ccd-96d0-fbeec1aeb208
Kommalapati, Varun
1059971e-4213-425b-988a-aa056b4b82ea
Casey, Joanne
0f6e606c-288f-443d-9bdb-6af68580b902
Bates, Maureen
8c28bf06-b37c-412a-a6af-a37c075a4776
Vas, Prashanth
57296e9a-b307-4e50-a316-06992981c587

Kavarthapu, Venu, Giddie, Jasdeep, Kommalapati, Varun, Casey, Joanne, Bates, Maureen and Vas, Prashanth (2023) Evaluation of adjuvant antibiotic loaded injectable bio-composite material in diabetic foot osteomyelitis and Charcot foot reconstruction. Journal of Clinical Medicine, 12 (9). (doi:10.3390/jcm12093239).

Record type: Article

Abstract

The management of diabetic foot osteomyelitis (DFO) is extremely challenging with high amputation rates reported alongside a five-year mortality risk of more than fifty percent. We describe our experience in using adjuvant antibiotic-loaded bio-composite material (Cerament) in the surgical management of DFO and infected Charcot foot reconstruction. We undertook a retrospective evaluation of 53 consecutive patients (54 feet) who underwent Gentamicin or Vancomycin-loaded Cerament application during surgery. The feet were categorised into two groups: Group 1, with infected ulcer and DFO, managed with radical debridement only (n = 17), and Group 2, requiring reconstruction surgery for infected and deformed Charcot foot. Group 2 was further subdivided into 2a, with feet previously cleared of infection and undergoing a single-stage reconstruction (n = 19), and 2b, with feet having an active infection managed with a two-stage reconstruction (n = 18). The mean age was 56 years (27–83) and 59% (31/53) were males. The mean BMI was 30.2 kg/m2 (20.8–45.5). Foot ulcers were present in 69% (37/54) feet. At a mean follow-up of 30 months (12–98), there were two patients lost to follow up and the mortality rate was 11% (n = 5). The mean duration of post-operative systemic antibiotic administration was 20 days (4–42). Thirteen out of fifteen feet (87%) in group 1 achieved complete eradication of infection. There was a 100% primary ulcer resolution, 100% limb salvage and 76% bony union rate within Group 2. However, five patients, all in group 2, required reoperations due to problems with bone union. The use of antibiotic-loaded Cerament resulted in a high proportion of patients achieving infection clearance, functional limb salvage and decrease in the duration of postoperative antibiotic therapy. Larger, preferably randomised, studies are required to further validate these observations.

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Accepted/In Press date: 18 April 2023
Published date: 1 May 2023

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Local EPrints ID: 486461
URI: http://eprints.soton.ac.uk/id/eprint/486461
ISSN: 2077-0383
PURE UUID: 733b94f1-4aa2-422b-9ec0-0367636f2463

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Date deposited: 23 Jan 2024 17:36
Last modified: 17 Mar 2024 07:08

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Contributors

Author: Venu Kavarthapu
Author: Jasdeep Giddie
Author: Varun Kommalapati
Author: Joanne Casey
Author: Maureen Bates
Author: Prashanth Vas

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