Evaluating Negative Margins in Foot Amputations for Diabetic Osteomyelitis: How Do We Decide?

Area of Science:

• Orthopedics
• Infectious Diseases
• Radiology

Background:

• Diabetic foot osteomyelitis (DFO) amputation levels are subjectively determined by surgeons.
• Current methods for assessing bone infection and resection margins lack standardization.
• Objective measures are needed to improve amputation level determination and infection assessment in DFO.

Purpose of the Study:

• To systematically review objective measures for determining amputation levels in diabetic toe and forefoot amputations.
• To evaluate the accuracy of different methods for assessing persistent infection at surgical margins.

Main Methods:

• Systematic review of studies from 1990-2023 on DFO amputation margin assessment.
• Included studies followed PRISMA guidelines.
• Data summarized on amputation level determination and infection assessment techniques.

Main Results:

• 18 studies met inclusion criteria; all used plain radiographs.
• Magnetic resonance imaging (MRI) was used in 13 studies for amputation level and 3 for resection depth.
• Positive margins were associated with higher treatment failure rates (7 studies).

Conclusions:

• A combination of plain radiographs and MRI is commonly used for amputation level determination.
• Positive surgical margins in DFO amputations correlate with increased antibiotic duration, infection, and reoperation rates.
• Optimizing surgical margin evaluation is crucial for better patient outcomes and reduced healthcare costs.