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 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.