A Novel Treatment Algorithem for Infected Diabetic Foot Ulcers- One Step Procedure

Abstract

Background Foot and ankle infections are the most common reason for hospital admissions and have the most devastating and costly complications in patients with diabetes mellitus worldwide. Foot ulceration can lead to a limb or even life-threatening infection. It is estimated that 85% of all amputations in diabetic patients are related to an ulcer and 59% of amputation are performed due to infection. When treating diabetic foot ulcers, achieving eradication of the infection and saving the limb can be difficult. In order to avoid amputation, which often is associated with functional impairment, the goal of treatment should be to be as preserving as possible. We would like to present our new treatment algorithm for infected diabetic foot ulcers in the first ray. This new algorithm avoid amputation and preserve ambulation. The new treatment algorithm includes: A thorough debridement of the ulcer, Primary stabilization by fusing the infected joint and closing the skin over the ulcer and the fused joint. We would like to present our experience with this new treatment algorithm. Methods This is a retrospective Study. The study includes 34 patients(36 feet) with IPJ or 1^st MTPJ septic arthritis or osteomyelitis due to diabetic ulcers between 2018-2021 treated in a tertiary referral hospital. All patients had preoperative radiographs, 17 patients had a preoperative MRI scan and were evaluated pre or postoperatively by angiography. A thorough debridement was performed until macroscopically judged clear of infection. Histology and microbiology samples were collected during surgery. The fusion of the infected joint was made under fluoroscopy control. Wound closure was performed with minimal soft tissue tension. All the patients were followed up for an average period of 12 months after surgery. Results By one year after surgery healing of the ulcer was achieved in 86% (31/36) of the cases. Overall average time to heal was 6.9 weeks (range 1-20 weeks). One year postoperatively radiological fusion was achieved in 26/36 (72%) cases. Clinically, by one year after surgery, 28 of 36 cases (77%) were stable on physical examination. Conclusion One Step Debridement and Arthrodesis of IPJ or 1^st MTPJ in diabetic foot patients with an ulcer and infection proved to be a successful way of treatment. A thorough debridement of the infected tissue and stabilizing the joint in the same procedure dramatically reduce the number of 1^st toe or 1^st ray amputation, improve patient’s satisfaction and help maintain a good walking pattern and mobilization. Level of Evidence: III