Preserving the diabetic foot - outcomes of diabetic foot ulceration and osteomyelitis treated with antibiotic loaded stimulan

B. Kapur, T. El Gamel, D. Harvey, G. Jackson, S. Platt

Background: Osteomyelitis can be limb and life threatening with devastating consequences. There is a role for medical and surgical management. Antibiotics can be locally delivered using methyl methacrylate or impregnated absorbable gauze. Calcium sulphate-based antibiotic therapy allows high concentration local delivery of a combination of antibiotics. Diabetic patients are predisposed to infection with varied and complex microbial load.

Aim: To establish the outcomes of patients with diabetic foot ulceration and osteomyelitis treated with antibiotic loaded Stimulan.

Methods: Retrospective data collection of patients treated with debridement, bone preserving surgery and antibiotic loaded stimulan for osteomyelitis of the foot treated by 2 orthopaedic consultants at Wirral University Teaching Hospital Trust between March 2014 and December 2015. Clinic documentation, MDT outcome and imaging were reviewed.

Results: 50 patients treated. 7 patients managed with vancomycin 1g in stimulan and 44 with vancomycin and gentamicin 240mg. 39/50 forefoot, 9/50 hindfoot and 2/50 midfoot. A multitude of organisms were identified including staphylococcus aureus, citrobacter, pseudomonas, haemolytic streptococcus, e. coli and enterococcus. All patients were discussed at MDT. Patients received augmentin and the antibiotics were changed based on microbiology results. 86% (43/50) had no further surgery within 12 months. 14% (7/50) patients went on to have further surgery linked to their initial procedure. Follow up 6 months - 24 months.

Conclusion: In our experience, bone preserving surgery and antibiotic loaded stimulan provides safe and effective local delivery of high concentration antibiotics in the presence of osteomyelitis reducing the need for amputation in a compliant patient with excellent 1 year outcomes.