Staged Antibiotic-Loaded Cement-Based Reconstruction Versus Flap-Based Reconstruction for Complex Diabetic Foot Defects in Patients with Osteoporosis: A Retrospective Cohort Study
Summary: This retrospective cohort study compared two surgical approaches for complex diabetic foot defects with osteomyelitis in patients with concurrent osteoporosis. The staged antibiotic-loaded bone cement combined with negative pressure wound therapy (AB-NPWT) group was compared to the flap transplantation group. In the flap group, a **Total Contact Cast (TCC)** was applied for the first 2 weeks post-flap (changed weekly), followed by a removable cast walker (RCW) for the next 2 weeks. Both approaches achieved similar high rates of wound healing and limb salvage.
Key Highlights:
- Total Contact Cast (TCC) used for initial 2 weeks in flap pathway to protect microvascular anastomosis
- Similar wound healing (~87%) and limb salvage (~93%) rates between AB-NPWT and flap + TCC groups
- AB-NPWT associated with shorter operative time and less blood loss
- Emphasizes importance of strict offloading with TCC in complex diabetic foot reconstruction
Keywords: Total Contact Cast, TCC diabetic foot, flap reconstruction DFU, antibiotic cement DFU