Is Stimulan (synthetic calcium sulphate tablets impregnated with antibiotics) superior in the management of diabetic foot ulcers with osteomyelitis compared to standard treatment?

M. Raglan, S. Dhar, B. Scammell

Background: Diabetes is bad, common and diabetic foot ulcers (DFU) once established lead to high rates of amputation. In Nottingham our standard management for infected diabetic foot ulcers is surgical debridement, microbiological sampling, packing with gentamicin beads and targeted antibiotic therapy. Recently we have switched to packing with Stimulan, which is a purified synthetic calcium sulphate compound that can be mixed with patient appropriate antibiotics, is biodegradable and delivers better elution characteristics compared to gentamicin beads.

Aim: To assess the efficacy of Stimulan compared to Gentamicin beads in the surgical management of infected diabetic foot ulcers.

Methods: In 2012/13 the department audited its results of DFU surgical management with gentamicin beads. In 2014/5 the audit was repeated but Stimulan was used instead due to the perceived advantages Patients with infected DFU that could comply with treatment were included. Patients who had other sources of sepsis, non-compliant or moribund were excluded. Treatment pathways were identical apart for the use of Stimulan in 2014/5. The primary outcome measure was ulcer healing. The secondary outcome measure was length of stay and recurrence.

Results: Each group had 23 patients. The gentamicin group had a DFU for 12.3 months(3weeks-5 years) before presentation for surgery compared to the Stimulan group 6.1 months(2weeks-5years). Both groups had failed non-surgical management. The majority of the ulcers were located on the forefoot. In the stimulan group 70% (16/23) of ulcers had healed with an average of 4 months(2-7 months) compared to 57% (13/23) in the Gentamicin group within 6months(1-12). The length of stay was shorter in the Stimulan group 7 days (1-70) compared to 28days(1-70) in the Gentamicin group.

Conclusion: In our review Stimulan was superior to Gentamicin beads in the management of infected diabetic foot ulcers. We believe it has a role to play in limb salvage.