SLR - January 2024 - Reddy
Title: Conservative Surgery for Diabetic Foot Osteomyelitis is not Associated With Longer Survival Time Without Recurrence of Foot Ulcer When Compared With AmputationReference: Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Rojas-Bonilla JM, Murillo-Vargas C. Conservative Surgery for Diabetic Foot Osteomyelitis is not Associated With Longer Survival Time Without Recurrence of Foot Ulcer When Compared With Amputation. Int J Low Extrem Wounds. 2023 Jun;22(2):328-331. doi: 10.1177/15347346211009403. Epub 2021 Apr 23. PMID: 33890818.
Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Malika Reddy, DPM
Residency Program: University Hospital, Newark, NJ
Podiatric Relevance: This is relevant for discussion in the treatment of diabetic foot osteomyelitis. Specifically this article evaluates the survival time without recurrence of foot ulcers and further amputations in conservative surgery versus amputation.
Methods: This is a retrospective cohort study. The study includes 108 patients who underwent surgery for diabetic foot osteomyelitis from January 2011 to December 2012 in the authors’ department. 44 patients were treated with conservative surgery and 64 patients with amputation. Patients were followed until May 2022. Outcome measures were survival without recurrences of ulcer and without need of new amputation after surgery.
Results: No significant difference was found with the rate of reinfection for the two groups. There was also no significant difference in cumulative survival without recurrences of ulcer and without need of new amputation after surgery at all measured times of 1, 5, and 8 years post-op. 41 patients passed away during follow up. In patients treated with conservative surgery the percentage of patients without recurrences of ulcer were 1 year: 95%, 5 years: 36%, and 8 years: 29%. In patients treated with amputation the percentage of patients without recurrences of ulcer were 1 year: 95%, 5 years: 43%, and 8 years: 30%. In patients treated with conservative surgery the percentage of patients without need of new amputation were 1 year: 100%, 5 years: 80%, and 8 years: 80%. In patients treated with amputation the percentage of patients without need of new amputation were 1 year: 98%, 5 years: 82%, and 8 years: 69%.
Conclusions: The authors conclude that conservative surgery when compared to amputation is as effective in controlling the spread of infection in the diabetic foot. Also, there is no significant difference in recurrence or need for additional amputation. Further, the authors seem to push for conservative surgery as this may have the advantage of lowering rate of recurrence and new amputations due to the minimization of biomechanical changes, although this was not seen in this study.
This manuscript adds perspective in treatment of diabetic foot osteomyelitis and prompts discussion on conservative surgery versus amputation. Of note, there is no detail on decision making when choosing whether a patient would be treated with conservative surgery versus amputation. Additionally, there is no detail of amputations within this group beyond minor (partial foot) and major (proximal to the ankle). The biomechanical stability of the foot should be considered during surgical planning in regards to the extent and level of amputation. This article describes the biomechanical outcome as being a passive result of the surgery of choice to control the infection versus one that is regarded during treatment.