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Article

Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite

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Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, Overijssel, The Netherlands
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Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, The Netherlands
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Department of Rehabilitation, University of Amsterdam, Amsterdam UMC, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, Noord-Holland, The Netherlands
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Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, Gelderland, The Netherlands
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Department of Surgery, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM Rotterdam, Zuid-Holland, The Netherlands
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Department of Surgery, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, Gelderland, The Netherlands
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Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun CF72 8UX, Wales, UK
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2021, 10(2), 371; https://doi.org/10.3390/jcm10020371
Received: 6 December 2020 / Revised: 5 January 2021 / Accepted: 15 January 2021 / Published: 19 January 2021
Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20–61) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065–13.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187–11.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608–9.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required. View Full-Text
Keywords: diabetes mellitus; foot ulcers; foot infections; gentamicin-loaded calcium sulphate-hydroxyapatite biocomposite; osteomyelitis; surgery diabetes mellitus; foot ulcers; foot infections; gentamicin-loaded calcium sulphate-hydroxyapatite biocomposite; osteomyelitis; surgery
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MDPI and ACS Style

Hutting, K.H.; aan de Stegge, W.B.; van Netten, J.J.; ten Cate, W.A.; Smeets, L.; Welten, G.M.J.M.; Scharn, D.M.; de Vries, J.-P.P.M.; van Baal, J.G. Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite. J. Clin. Med. 2021, 10, 371. https://doi.org/10.3390/jcm10020371

AMA Style

Hutting KH, aan de Stegge WB, van Netten JJ, ten Cate WA, Smeets L, Welten GMJM, Scharn DM, de Vries J-PPM, van Baal JG. Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite. Journal of Clinical Medicine. 2021; 10(2):371. https://doi.org/10.3390/jcm10020371

Chicago/Turabian Style

Hutting, Kor H., Wouter B. aan de Stegge, Jaap J. van Netten, Wouter A. ten Cate, Luuk Smeets, Gijs M.J.M. Welten, Dick M. Scharn, Jean-Paul P.M. de Vries, and Jeff G. van Baal 2021. "Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite" Journal of Clinical Medicine 10, no. 2: 371. https://doi.org/10.3390/jcm10020371

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