Limb salvage surgery paired with local antibiotic carriers offers an effective approach for treating diabetic foot osteomyelitis, according to clinical data published by surgical teams in the United Kingdom. Managing diabetic foot ulcers presents a significant challenge across healthcare systems, often complicated by multidrug-resistant pathogens, poor bone penetration of systemic antibiotics, and coexisting vascular disease.
In England alone, the prevalence of diabetic foot ulceration stands at approximately 58,000 cases, according to figures cited by Kerr et al. in 2019. Neuropathic ulcers frequently serve as an entry point for pathogens that cause osteomyelitis, establishing this condition as a leading driver of non-traumatic major limb amputations. Data from Kerr et al. indicate that roughly 7,000 patients in the UK lose a limb annually due to these complications, with overall non-healing ulcer amputation rates reaching up to 24 percent according to Pemayun et al. in 2015. The associated annual management costs exceed £1 billion.
To address these barriers, multidisciplinary teams at United Lincolnshire Hospitals NHS Trust and East and North Hertfordshire Hospitals NHS Trust evaluated the outcomes of 48 feet in 47 patients operated on between February 2017 and November 2019. The protocol utilized an antibiotic-loaded calcium sulphate hydroxyapatite biocomposite—specifically CERAMENT G, manufactured by BONESUPPORT in Lund, Sweden—as an adjuvant to surgical debridement or reconstructive procedures.
Multidisciplinary Evaluation and Surgical Protocols
Patient management relied on coordinated care from multidisciplinary diabetic foot teams. These groups comprise a diabetes physician, an orthopaedic foot surgeon, a vascular surgeon, a podiatrist, a microbiologist, and a musculoskeletal radiologist. Clinical assessments evaluated patients from orthopaedic, vascular, and endocrine perspectives, accompanied by comprehensive blood work including HbA1c, renal function tests, and inflammatory markers, alongside weight-bearing radiographs.
Diagnosis of osteomyelitis required meeting specific criteria established by Lipsky et al. in 2015, which include ulcers over bony prominences, discharging sinuses, visible exposed bone, positive probe-to-bone tests, or red, swollen toes with ulcers. Vascular assessment utilized hand-held Doppler scans to check for palpable pulses; patients exhibiting monophasic pulses or absent pulses underwent duplex scans and subsequent angiograms when necessary to evaluate distal run-off.
Single-Stage Operative Management
Surgical intervention followed a standardized single-stage procedure under regional or general anaesthesia, typically with a tourniquet applied. Sinus tracts were excised, and infected bone and soft tissue were debrided to prevent recurrence while preserving sufficient structural integrity. Exclusion criteria for the biocomposite protocol included documented gentamicin allergies and significant renal disease.
By combining targeted debridement with local antibiotic delivery via the calcium sulphate hydroxyapatite carrier, the surgical teams aimed to bypass the limitations of systemic antibiotic therapy and reduce major amputation rates in high-risk diabetic patients.
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