Journal of Infectious Diseases & Therapy
Open Access

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

Gil Genuth^1*, Martin Ulrich², George Klammer³ and Lukas D Iselin⁴

¹Department of Medicine, Assuta Medical Centre, Rothchild Blvd 90, Tel Aviv, Israel

²Department of Medicine, Kantonsspital Luzern, Spitalstrasse, 6000 Luzern, Switzerland

³Department of Medicine, Fussinstitut Zurich, Beethovenstrasse 3, 8002 Zurich, Switzerland

⁴Department of Medicine, Orthopadische Klinik Luzern AG, St Anna Strasse 28, 6006 Luzern, Switzerland

Received Date: May 03, 2024 / Published Date: Jun 05, 2024

Citation: Genuth G, Ulrich M, Klammer G, Iselin LD. (2024) A Novel Treatment Algorithem for Infected Diabetic Foot Ulcers-One Step Procedure. J Infect Dis Ther S7:002.DOI: 10.4173/2332-0877.24.S7.004

Copyright: © 2024 Genuth G, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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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 avoids amputation and preserve ambulation. 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: 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.

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