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Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite

Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multice...

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Autores principales: Hutting, Kor H., aan de Stegge, Wouter B., van Netten, Jaap J., ten Cate, Wouter A., Smeets, Luuk, Welten, Gijs M. J. M., Scharn, Dick M., de Vries, Jean-Paul P. M., van Baal, Jeff G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835819/
https://www.ncbi.nlm.nih.gov/pubmed/33478085
http://dx.doi.org/10.3390/jcm10020371
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author Hutting, Kor H.
aan de Stegge, Wouter B.
van Netten, Jaap J.
ten Cate, Wouter A.
Smeets, Luuk
Welten, Gijs M. J. M.
Scharn, Dick M.
de Vries, Jean-Paul P. M.
van Baal, Jeff G.
author_facet Hutting, Kor H.
aan de Stegge, Wouter B.
van Netten, Jaap J.
ten Cate, Wouter A.
Smeets, Luuk
Welten, Gijs M. J. M.
Scharn, Dick M.
de Vries, Jean-Paul P. M.
van Baal, Jeff G.
author_sort Hutting, Kor H.
collection PubMed
description Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187–11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608–9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.
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spelling pubmed-78358192021-01-27 Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite Hutting, Kor H. aan de Stegge, Wouter B. van Netten, Jaap J. ten Cate, Wouter A. Smeets, Luuk Welten, Gijs M. J. M. Scharn, Dick M. de Vries, Jean-Paul P. M. van Baal, Jeff G. J Clin Med Article Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187–11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608–9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required. MDPI 2021-01-19 /pmc/articles/PMC7835819/ /pubmed/33478085 http://dx.doi.org/10.3390/jcm10020371 Text en © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Hutting, Kor H.
aan de Stegge, Wouter B.
van Netten, Jaap J.
ten Cate, Wouter A.
Smeets, Luuk
Welten, Gijs M. J. M.
Scharn, Dick M.
de Vries, Jean-Paul P. M.
van Baal, Jeff G.
Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite
title Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite
title_full Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite
title_fullStr Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite
title_full_unstemmed Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite
title_short Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite
title_sort surgical treatment of diabetic foot ulcers complicated by osteomyelitis with gentamicin-loaded calcium sulphate-hydroxyapatite biocomposite
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835819/
https://www.ncbi.nlm.nih.gov/pubmed/33478085
http://dx.doi.org/10.3390/jcm10020371
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