The aim of this study was to evaluate the prevalence and extent of lower extremity Mönckeberg's Medial Calcific Sclerosis (MMCS) in patients with and without diabetes in patients admitted to the hospital for foot infections. This study retrospectively reviewed 446 patients admitted to the hospital with a moderate or severe foot infection. We defined diabetes based on ADA criteria and reviewed electronic medical records for demographics, medical history and physical examination data. Anteriorposterior and lateral foot radiographs were examined to identify the presence and extent of vascular calcification. We categorised MMCS based on anatomical location: ankle joint to the navicular-cuneiform joint, Lis Franc joint to metatarsophalangeal joints and distal to the metatarsophalangeal joints. The prevalence of MMCS was 40.6%. The anatomic extent of MMCS was 19.3% in the toes, 34.3% in the metatarsals and 40.6% in the hindfoot/ankle. Calcification was not common solely in the dorsalis pedis artery (DP) (3.8%) or solely in the posterior tibial artery (PT) (7.0%). Usually, both DP and PT arteries were affected by MMCS (29.8%). The prevalence of MMCS was higher in people with diabetes (in hindfoot and ankle [50.1% vs. 9.9%, p ≤ 0.01]; metatarsals [42.6% vs. 5.9%, p ≤ 0.01]; and toes [23.8% vs. 4.0%, p ≤ 0.01]). People with diabetes were 8.9 (CI: 4.5-17.8) times more likely to have MMCS than those without diabetes. This is a group that often has poor perfusion and needs vascular assessment.The high prevalence of MMCS raises questions about the reliability of the conventional segmental arterial Doppler studies to diagnose PAD.

Objective To assess Mönckeberg's medial calcific sclerosis (MMCS) severity in patients with a diabetic foot infection. Methods This was an analysis of 2 randomized clinical trials in which we evaluated the treatment of 233 patients admitted to the hospital for moderate and severe foot infections. Arterial calcification was defined as visible radiopaque arteries on foot and ankle radiographs, recorded as the most distal visible artery involved (toes, metatarsals, and ankle/hindfoot). Results Most subjects (57.1%, n = 133) had MMCS, with extension to toes in 79 (59.4%), to metatarsals in 32 (24.1%), and to ankle/hindfoot in 22 patients (16.5%). In 7 patients (5.2%) MMCS was solely seen in dorsalis pedis (DP) artery, in 13 patients (9.8%) in posterior tibialis (PT) artery, and in 113 patients (85.0%) MMCS was seen in both arteries. Only 29.2% ( n = 68) of DP arteries and 34.8% (n = 81) of PT arteries were not compressible by Doppler. DP and PT arteries were not compressible more often in MMCS (DP 34.3% vs 20.4%, P = .02 and PT 43.1% vs 21.4%, P < .01), toe-brachial indices of ≥0.7 were significantly more common in people without MMCS (46.0% vs 67.4%, P < .01). In contrast, there were no differences in skin perfusion pressure measurements (>50 mmHg; 67.7% vs 68.0%, P = .96), waveforms (biphasic/triphasic 83.5% vs 77.0%, P = .22), and pulse volume recording (9.6 ± 3.3 vs 13.7 ± 36.0) between patients with and without MMCS. Conclusion MMCS is common in patients with diabetic foot infections. MMCS is associated with noncompressible arterial Doppler studies and likely interferes with the accuracy of arterial Doppler studies.

Objective: To compare the incidence of infection, healing and time to heal in patients treated with cryopreserved (CPAT) and lyopreserved amniotic tissue (LPAT) in complex diabetic surgical wound (CDFW). Methods: This single-blinded 12-week randomized clinical trial compared cryopreserved and lyopreserved amniotic cord tissue to treat complex diabetic foot wounds (CDFW). LPAT or CRAT was applied at baseline and again after four weeks. We enrolled subjects with UT2A-D and 3A-D wounds (depth to tendon, muscle, or bone with infection and/or PAD) and excluded subjects with ABI&lt;0.5 or TBI&lt;0.3, untreated osteomyelitis, and autoimmune diseases. We used a 3-D camera to evaluate wound area and volume. The Chi-squared test was used to compare clinical outcomes and the Wilcoxon Ranked Sum Test to compare wound area and volume. Results: The mean baseline wound areas were 12.9cm2 ±10.7 for CPAT and 11.7cm2 ±7.0 for LPAT. The mean baseline wound volume were 7.5cm3 ±8.1 for CPAT and 9.2cm3±10.2 for LPAT. There was no difference between CPAT and LPAT in healing (36.8% vs. 19.0%, p=0.21) and infection (10.5% vs. 9.5%, p=0.72). There was no difference in mean wound area reduction between CPAT and LPAT (75.9± 32.3% vs. 65.5±38.4%, p=0.41), nor in mean volume reduction (85.0±30.8% vs. 79.9±31.9%, p=0.61). When we stratified wound dimensions, there was no difference between CPAT and LPAT in subjects that had 90-99% wound volume reduction (36.8% vs. 47.6%), 70-89% wound volume reduction (15.8% vs 19.0%) and 0-69% wound volume reduction (10.5% vs. 19.0%). There was no difference between CPAT and LPAT in subjects that had 90-99% wound area reduction 90-99% (10.5% vs. 23.8%), 70-89% (26.3% vs. 19.0%) and 0-69% (26.3% vs. 38.1%). Conclusion: Cryopreserved and Lyopreserved amniotic tissue provided similar results in patients with complex diabetic foot wounds. Disclosure L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew. A.L.Killeen: Research Support; 3M/KCI, AstraZeneca, BioTissue surgical, Hologenix, LLC, Integra LifeSciences, Kent Imaging Inc., Microbion, PolarityTE, Inc., Smith+Nephew, Stark Enterprises, LLC, Xyken, VasoActiv, ViOptix. M.A.Suludere: None. P.Crisologo: None. Funding Smith & Nephew

Renal impairment considerations have largely been absent diabetic foot literature, despite evidence that people with severe renal impairment are at elevated risk complications following diabetic foot infections. We evaluated clinical outcomes in patients who were admitted to hospital with diabetic foot infections with severe renal impairment compared with patients without a disability. This was a retrospective study of patients with diabetes mellitus who had been hospitalized at a level 1 trauma center with moderate and severe diabetic foot infections. Patients were grouped according to their Glomerular Filtration Rate (GFR). Patients with severe renal impairment were defined as having a GFR &lt; 30mL/min. Primary outcomes were mortality, wound healing and reinfection rates. Primary and secondary outcomes were compared using multivariable regression RStudio. A total of 307 patients with diabetic foot infections (62 patients with SRI and 245 patients without SRI) were included in the analysis. Multivariate analysis revealed that patients with severe renal impairment had higher rates of peripheral arterial disease (87% vs 66.9%; p = 0.003) and lower hemoglobin levels (9.8 vs 12.0; p &lt;0.001). We found that patients with diabetes and severe renal impairment at admission had significantly lower glycosylated hemoglobin levels (7.2% vs 9.2%; p &lt; 0.001). There was no difference in severity of infections between the two groups. We found that diabetic patients with severe renal impairment had higher mortality rates (8.1% vs 2.0%; p = 0.044) and higher rates of re-admission of new infections at different sites (51.6% vs 22.9%; p &lt; 0.001). There was no significant difference between the other outcomes of interest (wound healing and reinfection). In conclusion, patients with severe renal impairment who were admitted to hospital moderate and severe diabetic foot infections had higher mortality rates and elevated readmission risk than those without severe renal impairment. Disclosure T.L.Coye: None. P.Crisologo: None. M.A.Suludere: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.

Aim: To evaluate the incidence of MRSA infection, re-infection, and the conversion of non-MRSA bacterial pathogens to MRSA in re-infections. Methods: This was a post hoc analysis of 233 patients that participated in an RCT for moderate and severe diabetic foot infections with 12-month outcomes. We used bone culture and/or pathology to define osteomyelitis (OM). Soft tissue infections (STI) were defined based on negative bone biopsy or negative MRI. Moderate and severe infection was based on criteria of the International. Working Group on the Diabetic Foot infection classification. All subjects required surgery. We evaluated bacterial pathogens from bone and deep soft tissue from their initial infection and when there was re-infection. We defined conversion when a subject did not have MRSA in either their first OM or STI culture and had MRSA when there was re-infection. We used χ2 for comparison of clinical events, with alpha of &lt;0.05. Results: OM was present in 73.0% (n=170) of cases. MRSA incidence was 8.6% (n=20), with no difference between STI and OM (14.3% vs. 6.5%, p=0.06). Reinfection occurred in 29.2% (n=68), with no difference between STI and OM (36.5% vs. 26.5%, p=0.14). MRSA was seen in 29.4% (n=20) of the reinfections, with no difference between STI and OM (13.0% vs. 28.9%, p=0.16). Conversion to MRSA was seen in 14.7% (n=10), with no difference between STI and OM (4.3% vs. 20%, p=0.12). MRSA was 4.4 times more likely in re-infection compared to index infections (29.4% vs 8.6%, CI 2.2-8.9, p&lt;0.01). Conclusion: The incidence of MRSA is 4.4-fold higher after re-infection. The incidence of MRSA for the first infection (8.6%) was low. Re-infection with MRSA (29.4%) and conversion to MRSA (14.7%) were common. There was no difference seen in the incidence rates for reinfection, MRSA, reinfection with MRSA, and conversion to MRSA between patients with STI and OM. Disclosure M.A.Suludere: None. A.L.Killeen: Research Support; 3M/KCI, AstraZeneca, BioTissue surgical, Hologenix, LLC, Integra LifeSciences, Kent Imaging Inc., Microbion, PolarityTE, Inc., Smith+Nephew, Stark Enterprises, LLC, Xyken, VasoActiv, ViOptix. P.Crisologo: None. L.A.Lavery: Research Support; AstraZeneca, Tissue tech, American Diabetes Association, PolarityTE, Inc., Microbion, Jarvis, Integra Lifesciences Holdings Corp, Smith+Nephew.