Transform diabetic foot osteomyelitis
Courtesy of Caoimhe Joyce-Hearne Vascular Podiatrist, Guy’s and St Thomas’ NHS Foundation Trust, London, England, UK
57 year old male with a history of type 2 diabetes, arterial fibrillation, hypertension, dyslipidaemia and ischaemic heart disease.
The patient was initially admitted to the hospital with necrotic toes complicated by chronic limb threatening ischaemia (CLTI). He underwent a right transmetatarsal amputation and right popliteal angioplasty to increase blood flow to his foot.
While in hospital he developed a left heel pressure ulceration with necrosis that became boggy. The MRI found that there was focal osteomyelitis on his left lateral calcaneus. The area was surgically debrided under vascular to clear all the dead devitalised soft tissue.
The patient’s microbiology from surgery grew Enterobacter cloacae, Escherichia coli and Candida aureus. He was discussed in the multidisciplinary meeting and was prescribed Ciprofloxacin 500 mg BD and Doxycycline 100 mg BD for 6-weeks, as well as an application of 10 cc STIMULAN beads mixed with antibiotic to fill the dead space.
Heel wounds can be notoriously difficult to heal. The use of STIMULAN contributed to ulcer control and supported wound care. The wound was epithelised in less than 4 months. The beads dissolved in approximately 6 weeks. Following this, the wound was dressed and the patient was weight-bearing in a post-op shoe.
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