Tratamiento y evolución de úlceras de pie diabético con sospecha de osteomielitis en una unidad de pie diabético de nueva creación: estudio piloto observacional

• Mónica Arizmendi Pérez ^[1] ; Esther Bravo Ruiz ^[1] ; Raúl Torre Puente ^[1] ; Josu Mirena Baraia-Etxaburu Artetxe ^[1] ; Eider Etxeberria Martín ^[1] ; Javier Pascual Huerta ^[1]
  1. [1] OSI Bilbao-Basurto (Vizcaya). Hospital Universitario Basurto, Bilbao, España
• Localización: Revista española de podología, ISSN 0210-1238, Vol. 33, Nº. 1, 2022, págs. 29-34
• Idioma: español
• DOI: 10.20986/revesppod.2022.1624/2021
• Títulos paralelos:
  • Treatment and evolution of diabetic foot ulcers with suspected osteomyelitis in a recently new diabetic foot unit: observational pilot study
• Enlaces
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• Resumen
  • español

    Objetivos: El tratamiento de úlceras de pie diabético complicadas con osteomielitis (OM) sigue siendo un aspecto controvertido actualmente. Este trabajo presenta una serie de casos que muestra la experiencia de una unidad de nueva creación en el tratamiento y evolución de estos pacientes.

    Pacientes y métodos: Se analizaron retrospectivamente pacientes atendidos con ulceración activa y que cumplían criterios de sospecha de OM: Probe to Bone positivo junto con prueba de imagen (radiografía simple o RMN) sugestiva de OM. Se analizaron diversos datos de localización, tiempo de evolución, infección de partes blandas, enfermedad arterial periférica (EAP), tratamientos realizados (antibioterapia, curas, descarga y/o revascularización) y desenlace final del proceso entendido como curación de la úlcera o no.

    Resultados: Se incluyeron 12 episodios ulcerosos en 8 pacientes. Nueve episodios (75 %) estaban localizados en antepié y 3 (25 %) en retropié. Cinco (42 %) casos presentaban infección de partes blandas leve, 6 (50 %) moderada y 1 (8 %) severa. El 66,7 % (n = 8) curaron con tratamiento conservador (6 casos con antibiótico más descarga y 2 casos con descarga, sin asociar antibioterapia). El 33,3 % (n = 4) no se resolvieron y requirieron amputación (dos casos mayores y dos casos menores). De los casos con amputación, el 75 % (n = 3) asociaba EAP.

    Conclusiones: Pese a la limitación del tamaño muestral, esta serie refleja que el tratamiento conservador podría ser eficaz en este tipo de casos, señala la influencia de la EAP en el desenlace final de amputación y plantea nuevas hipótesis acerca del diagnóstico y tratamiento de estos pacientes.

  • English

    Objectives: Treatment of diabetic foot ulcers complicated with osteomyelitis (OM) is still a controversial issue. This work presents a case series showing the experience with these patients in a newly formed diabetic foot unit.

    Patients and methods: Patients with active foot ulcer and having the criteria of suspected OM (positive Probe to bone test with an image test, simple x-ray or MR, suggestive of OM) were analyzed retrospectively. Data of ulcer location, evolution time, soft tissue infection, peripheral arterial disease (PAD), treatments employed (antibiotics, dressings, offloading and/or revascularization) and final outcome (healed ulcer or not) were recorded and analyzed.

    Results: Twelve ulcer cases in 8 patients were included. Nine cases (75 %) were located in forefoot and 3 (25 %) in rearfoot. Five cases (42 %) had soft tissue infection, 6 (50 %) moderate and 1 (8 %) severe. The 66,7 % (n = 8) healed with conservative treatment (6 cases with antibiotics and offloading and 2 cases with offloading and no antibiotic therapy). Four cases (33,3 %) did not resolved and underwent amputation (2 mayor cases and 2 minor cases). Seventy-five percent of amputated cases (n = 3) had PAD.

    Conclusions: Despite the small sample size, this case series reflects that conservative treatment could be effective in these patients, it also shows the role of PAD in the final outcome of amputation and open new hypothesis about diagnoses and treatment for those patients.

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