The effects of peripheral vascular disease with 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 exposed bone, surrounding cellulitis, and gangrenous changes. METHODS: We performed a retrospective study over a 14-year period at a community hospital looking at osteomyelitis in the diabetic foot. We looked at the contributing factors, organisms involved, most common locations, physical findings, and surgical procedures necessary to treat this condition. The purpose of the study was to determine the incidence and effect of peripheral 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 total 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 the 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 ulcer that must be recognized and treated to avoid prolonged hospitalization, spreading infection, and unnecessary amputation.