NATIONAL HARBOR, Md. — Using an antibiotic spacer with extensive soft tissue excision and debridement has shown to be successful for treating severe osteomyelitis infections in the feet of diabetic patients, according to Israeli investigators.
In a review of 20 consecutive diabetic patients with 23 severe osteomyelitis infections, Eyal A. Melamed, MD, of Haifa, and colleagues demonstrated a 91.3% healing rate using the cement spacer concept.
“The role of the cement spacer would be to deliver high concentrations of antibiotics and that would be important to support soft tissue excision and debridement,” Melamed said in a presentation to the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society, here.
|Eyal A. Melamed|
The infections were located in the lesser metatarsal heads in nine patients, the first metatarsalophalangeal joints in seven patients, the hallucal interphalangeal joints in five and the proximal phalangeal joints in two patients.
Treatment consisted of extensive and meticulous excision and debridement with the gap created thereby with a cement spacer impregnated with gentamycin in all cases. Vancomycin was added to nine cases and amikacin was also added to one case. The spacers were fixed with K-wires when needed, Melamed said.
The mean follow-up was 21.2 months and deep cultures were taken routinely.
“Of the cases, 91% healed and two required toe amputations,” Melamed said. “The spacer was left in place in 10 patients, removed with arthrodesis in six and removed without arthrodesis in five.”
One patient healed, but subsequently underwent a below-the-knee amputation due to an infection at another site, he said.
“This procedure allowed avoidance of amputation in diabetic patients for whom amputation was indicated based on current practice,” he reported.
For more information:
- Melamed EA, Peled E. Antibiotic impregnated cement spacer for salvage of diabetic osteomyelitis. Presented at the 2010 Summer Meeting of the American Orthopaedic Foot and Ankle Society. May 8-10, 2010. National Harbor, Md.