Comparison Between Conservative and Operative Management of Diabetic Foot Having Bone Involvement
DOI:
https://doi.org/10.51253/pafmj.v74i1.9841Keywords:
Diabetes complications, Diabetic neuropathies Conservative management, Primary wound healing, Anti-bacterial agentsAbstract
Objective: To compare the efficacy of conservative and operative management of diabetic foot having bone involvement.
Study Design: Quasi-experimental study.
Place and Duration of study: Combined Military Hospital, Rawalpindi Pakistan, from May to Dec 2022.
Methodology: The study included all the patients with neuropathic diabetic foot ulcers worsened by bone
involvement/osteomyelitis. All the included patients were divided randomly into two equal groups, A and B (Conservative
and Operative Management Groups, respectively). They were followed up for the study period to assess the healing of the
wound. All the participants of the study were given antibiotics. Outcome measures were the proportion of patients achieving primary wound healing, hospitalization time, and wound healing time.
Results: In our study, we included 302 patients, amongst which 206(68.20%) were male subjects and 96(31.80%) were female subjects. The mean age was 33.89±7.57 years. The proportion of patients achieving primary wound healing in the Conservative Management-Group was 121(80.13%), and in the Operative Management-Group, it was 132(87.42%) (p=0.086). However, the difference between the duration of hospitalization and the time of wound healing was statistically insignificant (p-values of 0.199 and 0.538, respectively).
Conclusion: Conservative management with antibiotics alone may be a good alternative to operative management, avoiding surgical complications and costs.
Downloads
Metrics
References
Reardon R, Simring D, Kim B, Mortensen J, Williams D, Leslie A.
The diabetic foot ulcer. Aust J Gen Pract 2020; 49(5): 250-255.
https://doi.org/10.31128/AJGP-11-19-5161.
Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F,
Mohammadianinejad SE, et al. Incidence and risk factors of
diabetic foot ulcer: a population-based diabetic foot cohort
(ADFC Study)-two-year follow-up study. Int J Endocrinol 2018;
: 7631659. https://doi.org/10.1155/2018/7631659.
Singer AJ, Tassiopoulos, Kirsner RS. Evaluation and
management of lower-extremity ulcers. N Engl J Med 2018;
(3): 302-303. https://doi.org/10.1056/NEJMra1615243.
Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and
their recurrence. N Engl J Med 2017; 376(24): 2367-2375.
https://doi.org/10.1056/NEJMra1615439.
Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M,
Embil JM, et al. Guidelines on the diagnosis andtreatment of foot
infection in persons with diabetes (IWGDF2019 update).
Diabetes Metab Res Rev 2020; 36(Suppl_1): e3280.
https://doi.org/10.1002/dmrr.3280.
Aragón-Sánchez J, Lipsky BA. Modern management ofdiabetic
foot osteomyelitis. The when, how and why ofconservative
approaches. Expert Rev Anti Infect Ther 2018; 16(1): 35-50.
https://doi.org/10.1080/14787210.2018.1417037.
Ertuğrul B, Uçkay I, Schöni M, Peter-Riesch B, Lipsky BA.
Management of diabetic foot infections in the light of
recentliterature and new international guidelines. Expert Rev
Anti Infect Ther 2020; 18(4): 293-305.
https://doi.org 10.1080/14787210.2020.1730177.
Vas PRJ, Demetriou M, Papanas N. Oral antibiotic therapy in
diabetic foot osteomyelitis: one small step or a giant leap of faith?
Ann Transl Med 2019; 7(Suppl 8): S266.
https://doi.org 10.21037/atm.2019.12.53.
Tardáguila-García A, Sanz-Corbalán I, García-Alamino JM,
Ahluwalia R, Uccioli L, Lázaro-Martínez JL, et al. Medical versus
surgical treatment for the management of diabetic foot
osteomyelitis:a systematic review. J Clin Med 2021; 10(6): 1237.
https://doi.org 10.3390/jcm10061237.
Ahluwalia R, Lázaro-Martínez JL, Reichert I, Maffulli N.
Advances in pharmacotherapy for diabetic foot osteomyelitis.
Expert Opin Pharmacother 2021; 22(16): 2281-2291.
https://doi.org 10.1080/14656566.2021.1954159.
Lázaro-Martínez JL, Aragón-Sánchez J, García-Morales E.
Antibiotics versus conservative surgery for treating diabetic foot
osteomyelitis: a randomized comparative trial. Diabetes Care
; 37(3): 789-795. https://doi.org10.2337/dc13-1526.
American Diabetes Association Professional Practice Committee.
Classification and Diagnosis of Diabetes: Standards of Medical
Care in Diabetes-2022. Diabetes Care 2022 ;45(Suppl 1): S17-S38.
https://doi.org 10.2337/dc22-S002.
Malhotra R, Chan CS, Nather A. Osteomyelitis in the diabetic
foot. Diabet Foot Ankle 2014; 5.
https://doi.org 10.3402/dfa.v5.24445.
Pineda C, Espinosa R, Pena A. Radiographic imaging in
osteomyelitis: the role of plain radiography, computed
tomography, ultrasonography, magnetic resonance imaging, and
scintigraphy. Semin Plast Surg 2009; 23(2): 80-89.
https://doi.org 10.1055/s-0029-1214160.
Mishra P, Pandey CM, Singh U, Gupta A, Sahu C, Keshri A, et al.
Descriptive statistics and normality tests for statistical data. Ann
Card Anaesth 2019; 22(1): 67-72.
https://doi.org 10.4103/aca.ACA_157_18.
Forsythe RO, Hinchliffe RJ. Assessment of foot perfusion in
patients with a diabetic foot ulcer. Diabetes Metab Res Rev 2016;
(Suppl_1): 232-238. https://doi.org 10.1002/dmrr.2756.
Loupa CV, Meimeti E, Voyatzoglou E, Donou A, Koutsantoniou
E, Lafoyanni S, et al. Successful nonsurgical therapy of a diabetic
foot osteomyelitis in a patient with peripheral artery disease with
almost complete radiological restoration. BMC Res Notes 2018;
(1): 579. https://doi.org 10.1186/s13104-018-3694-x.
Ha Van G, Siney H, Danan JP, Sachon C, Grimaldi A. Treatment
of osteomyelitis in the diabetic foot. Contribution of conservative
surgery. Diabetes Care 1996; 19(11): 1257-1260.
https://doi.org 10.2337/diacare.19.11.1257.
Ahmad S, Nazar M, Tahir YB, Nauman FE, Baig AQ, Ur-Rehman
MA, et al. A comparative study of antibiotic therapy with and
without bone debridement in diabetic foot osteomyelitis. Pak J
Med Health Sci 2021; 15(12): 3805-3807.
https://doi.org 10.53350/pjmhs2115123805.
Ulcay A, Karakas A, Mutluoglu M, Uzun G, Turhan V, Ay H.
Antibiotherapy with and without bone debridement in diabetic
foot osteomyelitis: A retrospective cohort study. Pak J Med Sci
; 30(1): 28-31. https://doi.org 10.12669/pjms.301.4266
Downloads
Published
How to Cite
Issue
Section
