The effects of peripheral vascular disease with the osteomyelitis in the diabetic foot

BACKGROUND: Osteomyelitis in the diabetic foot is a difficult problem with multiple etiologies. The effects of peripheral vascular disease, neuropathy , and repetitive trauma all interact to produce complex lesions with expose d bone, surrounding cellulitis, and gangrenous changes. METHODS: We performed a retrospective study over a 14-year period at a comm unity hospital looking at osteomyelitis in the diabetic foot We looked at t he contributing factors, organisms involved, most common locations, physica l findings, and surgical procedures necessary to treat this condition. The purpose of the study was to determine the incidence and effect of periphera l vascular disease in diabetic patients with foot ulcers. RESULTS: There were a total of 150 patients requiring 278 hospitalizations over the 14-year period who represented 14% of all diabetic admissions. A t otal of 438 surgical procedures were necessary in these patients, with the most common being debridement (39%) and toe amputation (19%). There were 6 deaths (4%) in this series, and leg amputation was necessary in 21 patients (14%), A vascular bypass was necessary for healing and limb salvage in 36 patients (24%). Most of the bypasses (85%) were with autogenous tissue to t he distal leg in order to limit the extent of amputation and to preserve a functional limb. CONCLUSION: Ischemia is often a contributing factor in the diabetic foot ul cer that must be recognized and treated to avoid prolonged hospitalization, spreading infection, and unnecessary amputation. Am J Surg. 1999;177:282-2 86. (C) 1999 by Excerpta Medica, Inc.