TREATMENT OF DIABETIC (NEUROPATHIC) FOOT ULCERS WITH 2-STAGE DEBRIDEMENT AND CLOSURE

We reviewed 33 patients with 37 wounds treated between November of 199 1 and December of 1995 in the Wound Care Center. A two-stage debrideme nt and closure technique for neuropathic foot ulcers was performed. Pa tients selected included those with obvious osteomyelitis and those wh o had failed nonsurgical treatment. The approach included initial surg ical excision of the ulcer with biopsy, bone resection with biopsy, an d deep culture. The second-stage procedure 4 to 8 days later included debridement of the wound and delayed closure. Intravenous antibiotic t reatment using a central line was given postoperatively in patients wi th documented osteomyelitis for at least 6 weeks and in patients with infected soft tissues only for about 4 weeks. All patients remained no nweightbearing for 4 weeks; this was felt necessary to prevent separat ion of the wound edges. Four wounds in four patients failed to heal, a nd two of these went on to amputation. Satisfactory healing occurred i n 29 of 33 patients and in 33 of 37 wounds. The authors conclude that two-stage surgical debridement and closure is an acceptable treatment in selected nonhealing diabetic (neuropathic) foot ulcers.