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Category: Diabetes; Other Introduction/Purpose: Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper OxideDressings (COD) in the management of diabetic foot wounds (DFW). Methods: A Randomized controlled trial (RCT) lasting three months with 46 Diabetic Foot Wounds (DFW), recovering from infectious episodes that necessitated debridement or partial foot amputation. Patients in whom the wound was stable with resolution of the infection and in whom NPWT was indicated were enrolled in the study: 23 patients in the COD arm and 23 in the control NPWT arm. NPWT was succeeded by Aquacell extra or Granuflex dressings for up to 3 months. The primary endpoint was wound size reduction, assessed by an artificial intelligence program. The study was set as a non-inferiority study with a 20% margin. Secondary endpoints were convenience to the patient and caregiver, and pain, were assessed by visual analog score (VAS); application time (minutes), and calculated cost. Results: Twenty-three patients participated in the study in each arm. Seven patients dropped from the study in the NPWT arm and one in the COD group. The initial wound area was 19.9±4.36 and 14.1±2.32 cm 2 in the COD and NPWT arms, respectively (p=0.25). Wound size reduction was statistically significant non-inferior of the COD Arm compared to the NPWT (p=0.04) and superior in the last visit (T-test, p=0.032). COD therapy was more convenient for the patients - VAS was 8.44 vs. 5.33; (p=0.002) and the medical personnel (8.29 vs. 6.0; p=0.007) and less painful (1.15 vs. 2.19; p=0.67) compared to NPWT. The COD's mean application time was shorter (8.5 vs. 13.25 minutes; p< 0.001). The cost of COD was calculated to be 84% less than NPWT treatment. Conclusion: This RCT study indicates statistically significant non-inferiority of COD dressing therapy than NPWT in terms of wound healing rate of DFW. Better convenience and reduced costs in the COD arm justify initial copper dressing attempts in patients with diabetic foot wounds before NPWT treatment.

Introduction: Despite the rising global awareness and improvement of socioeconomic and living standards, the prevalence of diabetic osteomyelitis (DOM) and its complications has been increasing rapidly. This study aims to investigate the long-term prognosis of DOM of the foot treated using antibiotic-impregnated cement spacer (ACS) and the contributing risk factors for reoperation. Methods and Materials: We retrospectively reviewed the data of 55 diabetic patients with Meggitt-Wagner Grade IIB wounds diagnosed with osteomyelitis of the foot, treated in our institution with excessive debridement, excision of the infected tissue, and implantation of antibiotic-impregnated cement spacer fixed with a Kirschner wire. Descriptive statistics, including patient demographics, were analyzed. Statistical analysis was performed using point-biserial correlation and a Chi-square test with Cramer’s V effect-size estimation to determine the relationship between reoperation and various parameters. Results: 55 patients (36 (65.45%) males and 19 (34.55%) females) with a median age of 64 (39–84) years were thoroughly analyzed throughout a median follow-up of 884 days (2–4671 days). Of the entire cohort, 29 (52.72%) patients achieved primary successful infection eradication without any further intervention, and 8 (14.54%) patients were successfully treated using a secondary procedure. More than half of the reoperated patients underwent the secondary intervention within less than a month after the primary ACS. When assessing correlation, age (r = 0.28, p = 0.04), gender (r = 0.31, p = 0.02), Staphylococcus aureus (r = −0.10, p = 0.04), and the use of gentamicin-only antibiotic cement spacer (r = 0.34, p = 0.01) demonstrated statistically significant correlation to reoperation. 89.18% of the patients who achieved infection eradication did not undergo cement removal. Conclusions: ACS has shown excellent results in eradicating bone infection with up to 7.23 years of follow-up, acting as a structural stabilizer, preventing soft tissue contractures, and delivering highly concentrated local antibiotic treatment both to soft tissue and bone. Regardless, specific factors should be thoroughly evaluated prior to surgery, as advancing age, gender, and the use of gentamicin-only antibiotics appear to be positively associated with a higher likelihood of reoperation. Conversely, infections caused by cultured Staphylococcus aureus seem to be inversely related to reoperation.

Category: Diabetes Introduction/Purpose: Diabetic foot infections (DFI) with osteomyelitis often requires minor amputation as a mean to achieve adequate debridement and infection eradication. In the past years we have developed and used a method of utilizing antibiotic impregnated cement spacer (ACS) in DFI surgeries. The ACS release antibiotic locally, fill the cavity created by the extensive debridement of infected bone and stabilize the area to encourage healing. This is a long term report on using ACS in cases of severe DFI. Methods: 67 cases of severe forefoot DFI with osteomyelitis in 56 consecutive patients (one patient could have several cases in different times and/or sites), mean age 57 ± 11.7 years. Follow-up was 6 to 125 months (mean 39.7± 30 months). Extensive meticulous debridement followed ACS to fill the gap were employed in all cases. ACS contained Gentamycin and Vancomycin routinely and Amikacin in selected cases. Deep cultures were taken routinely. Stabilization was usually achieved Fixation with Kirschner Wires. Success defined as resolution of infection and wound healing without amputation. Results: Of the 67 cases 50 (75.7%) healed in 45 patients. Of the 12 patients (17 cases) who did not heal 4 required toe amputation, 2 ray amputation, 1 transmetatarsal amputation and 5 trans tibial amputation.. Of the ACSs: 23 left permanently 12 removed and arthrodesis was performed, and 15 removed without arthrodesis. Two patients recovered but subsequently underwent trans-tibial amputation (after 18 months and 5 years) due to infection in different site. Conclusion: ACS is effective and sometimes indispensable adjunct in the surgical treatment of forefoot DFI with osteomyelitis, when extensive debridement is undertaken to eradicate the infection without amputation. ACS stabilizes the infected part; fill the void created by the debridement and release locally broad spectrum antibiotic.