Treatment of Diabetic Foot Osteomyelitis: A Surgical Critique

Javier Aragn-Snchez, MD, PhD Surgery Department, Diabetic Foot Unit, La Paloma Hospital, Las Palmas de Gran Canaria, Spain, javiaragon@telefonica.net

Abstract
Osteomyelitis is one of the most frequent infections of the diabetic foot accounting for 10-15% of mild infections and almost 50% of severe infections. The definitive diagnosis of foot osteomyelitis requires obtaining bone samples for microbiological and histopathological studies. The treatment of osteomyelitis of the foot in diabetic patients continues to be debated. Until recently, most experts considered that the standard treatment for diabetic foot osteomyelitis should be the surgical removal of infected bone. Recent data suggest that antibiotic treatment can achieve an apparent remission of osteomyelitis though it is difficult to identify patients for this approach. One of the main arguments used to justify the solely antibiotic treatment of osteomyelitis is the alteration of foot biomechanics produced as a consequence of surgery. Conservative surgery combined with antibiotics is an attractive option in treating diabetic foot osteomyelitis because it may reduce the changes in the biomechanics of the foot and minimize the duration of antibiotic therapy. It is currently accepted that the combination of antibiotics with surgical removal of the infected bone may cure the majority of diabetic foot osteomyelitis. Recent literature emphasizes the role of antibiotics in the management of foot infections while little effort is dedicated to reviewing the surgical treatment of this challenging diabetic complication, apart from amputation. More research, including studies of adjunctive therapies in cases of bone infection in the feet of diabetic patients is required.

Reaction:
This study needs further tests but as a student nurse, I should give more attention on assessing the clients condition. Whatever treatment is more effective it is still important to note important details on clients condition before, during and after such procedures as well as to ascertain the effects of any drugs. In this study, amputation and antibiotic was the treatment for the diabetic foot that leads to osteomyelitis, for me, amputation can lessen the spread of the bacteria if not treated by the antibiotics. We must focus on the patients condition before doing any procedures because amputating one part of the body, amputating can make a person worthless and irresponsible, so before doing any procedure to the diabetic patient, we must know the feelings and inside thoughts of the patient because it will cost a lot on the patient upon doing some procedure especially amputation.