National trends in incidence and outcomes in lower extremity amputations in people with and without diabetes in Spain, 2001-2012.

Aims: To describe trends in the incidence and outcomes of lower-extremity amputations (LEAs) in patients with T1DM and T2DM in Spain, 2001-2012.

Methods: We used national hospital discharge data. Incidence of discharges attributed to LEA procedures were calculated stratified by diabetes status and type of LEA.

Staphylococcus aureus-Related Diabetic Osteomyelitis: Medical or Surgical Management? A French and Spanish Retrospective Cohort.

Staphylococcus aureus is the main cause of diabetic foot osteomyelitis (DFO) and can be treated medically or by surgery. We investigated the outcome of consecutive patients with a diagnosis of S aureus DFO retrospectively in 4 hospitals according to the type of management, medical (including debridement at bedside) or surgical. The outcome was classified as either favorable or failure (relapse, impaired wound healing, or amputation).

Conservative Surgery of Diabetic Forefoot Osteomyelitis: How Can I Operate on This Patient Without Amputation?

Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection.

The best way to reduce reulcerations: if you understand biomechanics of the diabetic foot, you can do it.

Foot ulcer recurrence is still an unresolved issue. Although several therapies have been described for preventing foot ulcers, the rates of reulcerations are very high. Footwear and insoles have been recommended as effective therapies that prevent the development of new ulcers; however, the majority of studies have analyzed their effects in terms of reducing peak plantar pressure rather than ulcer relapse.

Inter-observer reproducibility of diagnosis of diabetic foot osteomyelitis based on a combination of probe-to-bone test and simple radiography.

Probe-to-bone test and simple X-rays are both standard tests for the diagnosis of diabetic foot osteomyelitis. This study demonstrates the importance of considering jointly clinical information (probe-to-bone test) and diagnostic tests (simple radiography) to increase agreement among clinicians on diagnosis of diabetic foot osteomyelitis.

Albuminuria is a predictive factor of in-hospital mortality in patients with diabetes admitted for foot disease.

Albuminuria has been previously reported as a risk factor for mortality in people with diabetes. In a retrospective series of 455 patients with diabetes and foot ulcers, albuminuria was a predictive factor of in-hospital mortality. Other predictive factors were: white blood cell count>12.

Revision surgery for diabetic foot infections: giving another chance to the patient.

Revision surgery (RS) is frequently needed to control diabetic foot infections. It is the aim of this retrospective observational study to analyze the variables associated with undergoing RS and the variables associated with undergoing a major amputation when RS was required. We conducted a retrospective study of patients with diabetes treated in our department during 10 years (January 1, 2000 to January 1, 2010) who had foot infections identifying those who required RS.

Charcot neuroarthropathy triggered and complicated by osteomyelitis. How limb salvage can be achieved.

Background: Charcot neuroarthropathy is a severe complication in the feet of patients with diabetes, which can lead to a major amputation. Osteomyelitis and surgery for osteomyelitis have been reported as trigger mechanisms of developing Charcot neuroarthropathy. However, the development of acute Charcot neuroarthropathy triggered by osteomyelitis during conservative antibiotic treatment is not well outlined in the medical literature.

Gram-negative diabetic foot osteomyelitis: risk factors and clinical presentation.

Osteomyelitis frequently complicates infections in the feet of patients with diabetes. Gram-positive cocci, especially Staphylococcus aureus, are the most commonly isolated pathogens, but gram-negative bacteria also cause some cases of diabetic foot osteomyelitis (DFO). These gram-negatives require different antibiotic regimens than those commonly directed at gram-positives.

Super-oxidized solution (Dermacyn Wound Care) as adjuvant treatment in the postoperative management of complicated diabetic foot osteomyelitis: preliminary experience in a specialized department.

Surgery is usually used to treat diabetic foot osteomyelitis (DFO), whether primarily or in cases in which antibiotics are not able to control infection. In many cases, the bone is only partially removed, which means that residual infection remains in the bone margins, and the wound is left open to heal by secondary intent. The use of culture-guided postoperative antibiotic treatment and adequate management of the wound must be addressed.

Controversies regarding radiological changes and variables predicting amputation in a surgical series of diabetic foot osteomyelitis.

Background: To investigate if radiological changes have any influence on the outcomes of surgical treatment of diabetic foot osteomyelitis.

Methods: Data of patients included in a prospective cohort who underwent surgical treatment for definitive osteomyelitis were analyzed. Cases were classified according to radiological changes as "early osteomyelitis" when no radiological changes were found or in cases showing periosteal elevation and/or subcortical demineralization and/or cortical disruption.

From the diabetic foot ulcer and beyond: how do foot infections spread in patients with diabetes?

A diabetic foot infection is usually the result of a pre-existing foot ulceration and is the leading cause of lower extremity amputation in patients with diabetes. It is widely accepted that diabetic foot infections may be challenging to treat for several reasons. The devastating effects of hyperglycemia on host defense, ischemia, multi-drug resistant bacteria and spreading of infection through the foot may complicate the course of diabetic foot infections.

Endovascular treatment is a hope for patient with Buerger's disease and foot ulcer: case report.

Scarce information exists regarding the usefulness of the endovascular approach in patients with thromboangiitis obliterans and critical ischemia. A 41-old-man diagnosed with Buerger's disease had rest pain and a severe ulceration on the big toe. He had been scheduled for a big toe amputation.

Clinical-pathological characterization of diabetic foot infections: grading the severity of osteomyelitis.

The present study has 3 aims: (a) to characterize the clinical and pathological features of diabetic foot infections, (b) to show the range of clinical presentations of moderate infections, and (c) to analyze the different behavior of diabetic foot osteomyelitis regarding to its clinical presentation. A definitive diagnosis of the type of infection was made based on intraoperative findings and histopathology. Diabetic foot infections were classified into 2 types: soft tissue and bone infections.

Evidences and controversies about recurrence of diabetic foot osteomyelitis: a personal view and an illustrated guide for understanding.

Recurrence is one of the most worrying issues when dealing with diabetic foot osteomyelitis (DFO). In accordance with expert opinion in other areas of bone infection, it is accepted that very late relapse of apparently successfully treated osteomyelitis is not uncommon. However, the physiopathology of infections in large bones secondary to hematogenous osteomyelitis, infected prostheses, and open fractures is quite different from what is seen in the feet of patients with diabetes.

Limb salvage for spreading midfoot osteomyelitis following diabetic foot surgery.

Osteomyelitis is a challenging problem when it appears in the feet of patients with diabetes. Although the most frequent port of entry for bacteria is an ulcer, surgical wounds also permit entry of bacteria into the foot. This surgical complication may become limb-threatening, and treatment is a challenge.

Does osteomyelitis in the feet of patients with diabetes really recur after surgical treatment? Natural history of a surgical series.

Aims/hypothesis: The aim of this study was to determine the rate of recurrence, reulceration and new episodes of osteomyelitis and the duration of postoperative antibiotic treatment in a prospective cohort of patients with diabetes who underwent conservative surgery for osteomyelitis.

Methods: The prospective cohort included patients with diabetes and a definitive diagnosis of osteomyelitis who were admitted to the Diabetic Foot Unit (Surgery Department, La Paloma Hospital, Las Palmas de Gran Canaria, Spain) and underwent surgical treatment from 1 November 2007 to 30 May 2010.

Results: Eighty-one patients were operated on for osteomyelitis during the study period.

Impact of perioperative glycaemia and glycated haemoglobin on the outcomes of the surgical treatment of diabetic foot osteomyelitis.

Perioperative glycaemic control during admission was a predictive factor of amputation in a prospective cohort of 81 patients with diabetes who underwent surgical treatment for osteomyelitis. Glycaemic control before admission, as determined by glycosylated haemoglobin, did not have any influence on the outcomes.

The role of a specialized approach for patients with diabetes, critical ischaemia and foot ulcers not previously considered for proactive management.

Aims: To analyse the outcome of the proactive management of patients with diabetes, critical limb ischaemia and foot ulcers using percutaneous transluminal angioplasty as the only vascular procedure and adjuvant conservative surgery when indicated.

Methods: A retrospective study of patients with diabetes included in our database who sought a second opinion in our unit and met the following criteria: foot ulcer and critical limb ischaemia in patients for whom any proactive vascular treatment had not previously been considered by other teams.

Results: Twenty patients underwent endovascular procedures.

Seminar review: A review of the basis of surgical treatment of diabetic foot infections.

Infection is an extremely challenging complication of foot ulcers in patients with diabetes. Surgery as part of a multidisciplinary approach is key in the management of many types of diabetic foot infections (DFIs). Unfortunately, the surgical treatment of DFIs is based more on clinical judgment and less on structured evidence, which leaves unresolved doubts.

Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone test and plain radiography sufficient for high-risk inpatients?

Aims: To investigate the accuracy of the sequential combination of the probe-to-bone test and plain X-rays for diagnosing osteomyelitis in the foot of patients with diabetes.

Methods: We prospectively compiled data on a series of 338 patients with diabetes with 356 episodes of foot infection who were hospitalized in the Diabetic Foot Unit of La Paloma Hospital from 1 October 2002 to 31 April 2010. For each patient we did a probe-to-bone test at the time of the initial evaluation and then obtained plain X-rays of the involved foot.

Triggering mechanisms of neuroarthropathy following conservative surgery for osteomyelitis.

Background: The purpose of this study was to raise awareness and stimulate discussion of the possible triggering factors of Charcot neuroarthropathy by presenting the case of one patient who had both undergone surgery and was suffering from osteomyelitis.

Case Report: We have extracted one case from our data set for a patient who underwent conservative surgery for osteomyelitis and subsequently developed acute Charcot in the midfoot. We present the clinical findings, photographs and X-ray studies.