SLR - April 2013 - Andrea Di Croce
Reference: Garcia-Morales E, Lazaro-Martinez JL, Aragon-Sanchez FJ, Diabetic Foot and Ankle 2012, 3:19000
Scientific Journal Review
Reviewed by: Andrea Di Croce, DPM
Residency Program: Sisters of Charity Hospital, Buffalo, NY
Podiatric Relevance:
Osteomyelitis is the most common sequelae of diabetic foot infections, however, despite the incidence and relevance, there are currently no evidence-based therapeutic protocols. Osteomyelitis is traditionally treated with six weeks of IV antibiotic therapy solely or in conjunction with surgical debridement of the affected tissues. The objective of this study was to determine the complications associated with primary closure following surgical debridement versus that of closure by secondary intention in patients with diabetic foot osteomyelitis.
Methods:
This was a comparative study which included 46 patients with diabetic foot ulcers and osteomyelitis. There were 30 (65.2 percent) males and 16 (34.8 percent) females with an average age of 62.65±18 years. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique utilized, 34 patients (73.9 percent) had primary closure (Group 1), while 12 patients’ (26.1 percent) surgical sites were left open to heal by secondary intention (Group 2). Postoperatively, both were treated the same with off-loading. Post-surgical complications were recorded during follow-up.
Results:
The average healing time was 9.9±8.4 weeks in Group 1 versus 19.1±16.9 weeks in Group 2 (p=0.008). Percentage of total complications was 61.8 percent in Group 1 versus 58.3 percent in Group 2 (p=0.8). The different complications recorded were: Hematoma (5.9 percent in Group 1 with p<0.001), dehiscence (23.5 percent Group 1 with p<0.001), slough (11.8 percent in Group1 and 25 percent in Group 2 with a p=0.27), exudate (20.6 percent in Group 1 and 50 percent in Group 2 with a p=0.05), edema (16.7 percent in Group 2 with a p<0.001), re-infection (32.4 percent in Group 1 and 41.7 percent in Group 2 with a p= 0.56), pain (3.1 percent in Group 1 and 16.7 percent in Group 2 with p=0.1) and necrosis (9.4 percent in Group 1 and 8.3 percent in Group 2 with p=0.9).
Conclusion:
According to this study, patients who received primary closure healed sooner than secondary intention closure and the overall foot function and structure were preserved. The limitation of this study was too low of a number of patients to achieve statistically significant or conclusive data. Primary closure had similar complications but had lower percentage of exudates, edema and re-infection rate, comparatively. There is certainly a need for a follow-up study which might include a greater number of subjects.