Schmidt Brian M, McHugh Jonathan B, Patel Rajiv M, Wrobel James S
Division of Metabolism, Endrocrinology, and Diabetes, Department of Internal Medicine, Ann Arbor, Michigan (BMS, JSM).
Department of Pathology, Ann Arbor, Michigan (JBH, RMP).
Foot Ankle Spec. 2019 Apr;12(2):131-137. doi: 10.1177/1938640018770285. Epub 2018 Apr 12.
Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin.
Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded.
Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications.
Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes.
Prognostic, Level I: Prospective.
骨髓炎在糖尿病足感染中很常见，药物治疗可能导致不良预后。手术治疗需要送检组织病理学和微生物学标本，以指导后续干预。我们研究了前足截肢患者获取手术切缘的效果，以确定与预后相关的患者特征。次要目的包括评估手术骨切缘远端和近端组织病理学数据的观察者间可靠性。
前瞻性收集72例患者的数据并汇总进行分析。建立了标准化的术中获取骨切缘的方法。进行单因素分析。记录不良结局，包括大肢体截肢、伤口裂开、再溃疡、再次截肢或死亡。
72例中有63例（87.5%）获得了有活力的近端切缘。记录到组织病理学具有较高的观察者间可靠性。单因素分析表明，术前血小板、白蛋白、探针触骨试验、绝对趾压、较小的伤口表面积与获得有活力的切缘相关。残留骨髓炎导致再次入院的频率增加2.6倍，术后并发症更多。
有活力切缘组与污染切缘组的某些患者存在显著差异。证明了较高的观察者间可靠性。获得有活力的切缘可降低再次入院率和不良结局发生率。
预后性，I级：前瞻性研究。
