NL Vasukutty, S Mordecai, A Tarik, M Subramaniam, B Srinivasan
Diabetic foot disease is associated with high morbidity and is one of the leading causes of lower limb amputation. The use of a local antibiotic carrier to augment debridement and reconstructive procedures is presented. Methods: The authors present early results of 48 feet in 47 patients from two centres in the UK. Their multidisciplinary protocol involved pre-operative assessment, debridement, culture-specific antibiotics and local antimicrobial management with an antibiotic-loaded biocomposite (CERAMENT G®, BONESUPPORT, Lund, Sweden). Of the 48 feet, 22 (46%) had various foot reconstructive procedures. Six patients had pre-operative revascularisation procedures. All patients were graded as either University of Texas 3B or 3D ulcers. Results: At a mean follow-up of 33 months (range 13–49 months), 42 feet (88%) were free of infection and 39 patients (83%) were mobilising. There were 28 wounds healed by secondary intention, 17 with primary closure and three required skin grafting. Three patients had non-healing and persisting ulcers at the most recent follow-up. Three patients had undergone below–knee amputation. The average time to wound healing was 16 weeks (range 3–24 weeks). A limb salvage rate of 94% was achieved … read more