SLR - February 2012 - William Thetford
Reference: Kim B, Choi W, Baek M, Kim Y, and Lee J, Foot Ankle Int 32(1), 31-7, 2011.
Scientific Literature Review
Reviewed by: William Thetford, DPM, MS
Residency Program: Detroit Medical Center
Podiatric Relevance:
The podiatric foot and ankle surgeon is often times the consultant of choice in limb threatening diabetic foot infections. In a non-ambulatory or bedridden patient, primary amputation may be the best option. However, in an ambulatory patient limb salvage is preferred to allow for independent ambulation with heel weightbearing. This can be achieved by following an algorithm of emergent evacuation of an abscess along with clearance of the infection, appropriate debridement, wound bed preparation and application of negative pressure wound therapy (NPWT).
Methods:
Forty-five septic diabetic feet were treated with NPWT between 2006 and 2008. After emergent abscess evacuation, early vascular intervention was performed if necessary. Debridement, with or without partial foot amputation, was followed by NPWT. Wound progress was measured using a digital scanner. A limb was considered salvaged if complete healing was achieved without any or with minor amputation through or below the ankle.
Results:
The mean followup after complete wound healing was 17 (range, 6 to 35) months. Thirty-two cases (71 percent) were infected with two or more organisms. Negative pressure wound therapy was applied for 26.2 ± 14.3 days. The median time to achieve more than 75 percent wound area granulation was 23 (range, 4 to 55) days and 104 (range, 38 to 255) days to complete wound healing. Successful limb salvage was achieved in 44 cases (98 percent); 14 (31 percent) without any amputation and 30 (67 percent) with partial foot amputations. The total number of operations per limb was 2.4 ± 1.3. One case of repeated infection and necrosis was managed with a transtibial amputation. There were no complications associated with NPWT.
Conclusions:
Salvaging a limb is critical because reduced activity after major amputation can cause a variety of morbidities and increased risk of mortality. This study provides the outcome of a management algorithm, which includes NPWT in salvaging severely infected diabetic feet. With emergent evacuation of abscess, early vascular intervention and appropriate debridement, NPWT can be a useful addition to the management of limb threatening diabetic foot infections.