Efficacy of Magnetic Resonance Imaging in Diagnosing Diabetic Foot Osteomyelitis in the Presence of Ischemia

Fujii, Miki; Armsrong, David G.; Terashi, Hiroto

doi:10.1053/j.jfas.2013.07.009

Cited by 32 publications

(31 citation statements)

References 21 publications

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“…However, in some cases, the area of osteomyelitis was not correctly diagnosed by MRI because of severe ischemia, for these cases, we resected only the bones which were obviously affected by osteomyelitis. MRI depends on the presence of fluid, thus, the images of severe ischemic cases were unclear or equivocal because of insufficient interstitial fluid; as we previously reported . When soft tissue infection was spread more proximally or the blood supply was insufficient, resection was planned more proximally.…”

Section: Methodsmentioning

confidence: 97%

“…All patients were suspected of having osteomyelitis by a positive probe‐to‐bone test, swollen foot, sausage toe, an unexplained high leukocyte count or inflammatory markers, and plain foot radiographic findings. All cases were examined by MRI, and localization of osteomyelitis was evaluated as previously described . Surgical treatment was then performed.…”

Section: Methodsmentioning

confidence: 99%

“…We previously proposed that an appropriate surgical margin should be set in the area of bone marrow edema based on research using magnetic resonance imaging (MRI) and histopathology . In the present study, we evaluated the efficacy of surgery based on MRI examinations, factors predictive of early DFO healing after complete resection of osteomyelitis, and prognosis of patients, with the aim of establishing a surgical treatment strategy for DFO involving moderate to severe infection and ischemia.…”

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confidence: 99%

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Surgical treatment strategy for diabetic forefoot osteomyelitis

Fujii¹,

Terashi

Yokono³

2016

Wound Repair Regeneration

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.The aim of this study was to propose an appropriate surgical treatment for diabetic forefoot osteomyelitis (DFO) involving ischemia or moderate to severe soft tissue infection. The records of 28 patients with osteomyelitis from 2009 to 2015 were retrospectively studied. All patients had undergone surgery based on preoperative magnetic resonance imaging examinations and histopathological or culture analyses confirming the surgical bone margin. The appropriate surgical margin, crucial factors for early healing, and prognosis after complete resection of osteomyelitis were examined. After healing, patients were followed up to assess prognosis (range 32-1,910 days, median 546 days). The healing rate of nonischemic cases of DFO with negative surgical margins was 100% and that of ischemic cases was 84.6%; the ambulatory rates for both types of cases were 100%. No wound (and/or osteomyelitis) recurrence was observed. Nine new cases of DFO developed in six patients (21.4%; eight were due to vascular stenosis, and one was due to biomechanical changes in the foot. After complete resection of osteomyelitis, preoperative and postoperative C-reactive protein levels and the size of the ulcer were significant predictors of early healing (p < 0.05, 0.01, and 0.05, respectively). The appropriate surgical margin should be set in the area of bone marrow edema, based on magnetic resonance imaging examinations after revascularization. In cases with high preoperative or postoperative C-reactive protein levels, long-term antibiotic therapy is recommended, and surgery should be planned after the C-reactive protein levels decrease, except in emergencies.The best therapy for diabetic foot osteomyelitis (DFO), whether medical or surgical, is a controversial subject. 1Guidelines state that removing the infected bones and soft tissue is the most effective treatment because the period of antibiotic administration is shortened.2-4 However, no studies have shown how the level of bone resection should be determined. DFO with moderate to severe ischemia, i.e., critical limb ischemia, is associated with a high rate of limb loss and subsequent mortality, and is often related to failure of conservative therapy. 5,6 Currently, the appropriate amputation level for such severe DFO is unclear.We previously proposed that an appropriate surgical margin should be set in the area of bone marrow edema based on research using magnetic resonance imaging (MRI) and histopathology. [7][8][9] In the present study, we evaluated the efficacy of surgery based on MRI examinations, factors predictive of early DFO healing after complete resection of osteomyelitis, and prognosis of patients, with the aim of establishing a surgical treatment strategy for DFO involving moderate to severe infectio...

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Section: Methodsmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Surgical treatment strategy for diabetic forefoot osteomyelitis

Fujii¹,

Terashi

Yokono³

2016

Wound Repair Regeneration

Self Cite

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“…Furthermore, preoperative MRI in cases of diabetic foot osteomyelitis with ischemia may be less effective for distinguishing osteomyelitis from bone marrow edema than in cases of neuropathic ulcers. 18 In this article, the authors presented some case reports. One case dealing with osteomyelitis of the fifth metatarsophalangeal joint was approached using extensive amputation according to MRI findings.…”

Section: Is Removing All the Infected Bone Strictly Necessary To Curementioning

confidence: 99%

Conservative Surgery of Diabetic Forefoot Osteomyelitis

Aragón‐Sánchez

Lázaro‐Martínez

Álvaro‐Afonso

et al. 2014

The International Journal of Lower Extremity Wounds

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Surgery is necessary in many cases of diabetic foot osteomyelitis. The decision to undertake surgery should be based on the clinical presentation of diabetic foot osteomyelitis. Surgery is required when the bone is protruding through the ulcer, there is extensive bone destruction seen on x-ray or progressive bone damage on sequential x-ray while undergoing antibiotic treatment, the soft tissue envelope is destroyed, and there is gangrene or spreading soft tissue infection. Several issues should be taken into account when considering surgery for treating diabetic foot osteomyelitis. It is necessary to have a surgeon available with diabetic foot expertise. Regarding location of diabetic foot osteomyelitis, it is important to consider whether isolated bone or a joint is involved. In cases in which osteomyelitis is associated with a bone deformity, surgery should be able to correct this. The surgeon should always reflect about whether extensive/radical surgery could destabilize the foot. The forefoot is the most frequent location of diabetic foot osteomyelitis and is associated with better prognosis than midfoot and hindfoot osteomyelitis. Many surgical procedures can be performed in patients with diabetes and forefoot ulcers complicated by osteomyelitis while avoiding amputations. Performing conservative surgeries without amputations of any part of the foot is not always feasible in cases in which the infection has destroyed the soft tissue envelope. Attempting conservative surgery in such cases risks infected tissues remaining in the wound bed leading to failure. The election of different surgical options depends on the expertise of the surgeons selected for the multidisciplinary teams. It is the aim of this article to provide a sample of surgical techniques in order to remove the bone infection from the forefoot while avoiding amputations.

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“…Osteomyelitis is diagnosed by physical examination, laboratory values, plain X-ray film, and magnetic resonance imaging (MRI) findings. Of these, MRI is the most accurate imaging modality for detecting osteomyelitis [1]. However, even such an accurate imaging modality cannot predict the curability of osteomyelitis; it cannot be determined whether conservative therapy is enough, some intensive treatment is required, or infected bone removal is mandatory.…”

Section: Introductionmentioning

confidence: 99%

Successful limb salvage through staged bypass combined with free gracilis muscle transfer for critical limb ischemia with osteomyelitis after failed endovascular therapy

et al. 2018

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BackgroundCritical limb ischemia with osteomyelitis is so difficult to treat that even appropriate revascularization and wound therapy cannot achieve limb salvage because of uncontrollable infection. It is still difficult to judge the possibility of limb salvage before revascularization.Case presentationA 73-year-old male complained of a small ulcer on his left toe, which was treated with multiple endovascular therapy. After failed endovascular therapy, he suffered extensive tissue loss with tibial osteomyelitis. We carried out staged surgery that was composed of dual bypass to the sural artery and posterior tibial artery. After intensive debridement and wound care, insertion of a subsequent free gracilis muscle flap to cover the exposed tibial bone was performed, achieving functional limb salvage.ConclusionEven in the threatened limb with extensive tissue loss and osteomyelitis, intensive and multidisciplinary treatment with staged revascularization, muscle transfer, and appropriate wound care achieved functional limb salvage.

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Efficacy of Magnetic Resonance Imaging in Diagnosing Diabetic Foot Osteomyelitis in the Presence of Ischemia

Cited by 32 publications

References 21 publications

Surgical treatment strategy for diabetic forefoot osteomyelitis

Surgical treatment strategy for diabetic forefoot osteomyelitis

Conservative Surgery of Diabetic Forefoot Osteomyelitis

Successful limb salvage through staged bypass combined with free gracilis muscle transfer for critical limb ischemia with osteomyelitis after failed endovascular therapy

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