Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain.
J Tissue Viability. 2012 May;21(2):64-70. doi: 10.1016/j.jtv.2011.12.002. Epub 2012 Jan 9.
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. Here we present two cases of patients with neuropathic feet and palpable distal pulses, who were previously treated with surgery, and who presented with spreading bone infection in the midfoot. Pictures and radiological studies are shown. In both cases, bone infection caused severe destruction of the architecture of the midfoot, and the limbs of both patients were threatened. Midfoot osteomyelitis is associated with a higher rate of major amputations than osteomyelitis of the forefoot. Furthermore, meticillin-resistant Staphylococcus aureus was isolated in one of the cases. Our successful limb salvage approach was based on three steps: 1) removing the infected bone; 2) culture-guided antibiotic treatment; and 3) stabilizing the infected foot by means of total contact casting with openings resulting in a stable foot. To the best of our knowledge, there are no reports of the use of a total contact cast to stabilize an unstable and infected foot. Eight years (Case 1) and four years (Case 2) after complete healing, there were no recurrences of infection.
骨髓炎是糖尿病患者足部出现的一个具有挑战性的问题。尽管细菌最常见的入口是溃疡，但手术伤口也允许细菌进入足部。这种手术并发症可能会威胁到肢体，治疗是一个挑战。在这里，我们介绍了两例有神经病变的足部和可触及的远端脉搏的患者，他们之前曾接受过手术治疗，现在出现了中足部的骨感染扩散。展示了图片和影像学研究。在这两种情况下，骨感染都导致了中足部结构的严重破坏，这两个患者的肢体都受到了威胁。与前足部骨髓炎相比，中足部骨髓炎与更高的大截肢率相关。此外，在其中一例中分离出了耐甲氧西林金黄色葡萄球菌。我们成功的保肢方法基于三个步骤：1）清除感染的骨骼；2）进行培养指导的抗生素治疗；3）通过完全接触铸型固定感染的足部，铸型上的开口可使足部保持稳定。据我们所知，没有使用完全接触铸型来稳定不稳定和感染的足部的报道。在完全愈合后的 8 年（病例 1）和 4 年（病例 2），没有感染复发。
