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Staged antibiotic-loaded cement-based reconstruction versus flap-based reconstruction for complex diabetic foot
Hanlin Zhang1,2, Desheng Chen1,2, Qiang Song1,2
1Department of Orthopedics Center, People's Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, Ningxia, China.
Objective:
This retrospective cohort study aimed to compare the clinical efficacy and safety of a staged antibiotic-loaded bone cement combined with negative pressure wound therapy (AB-NPWT) pathway vs. flap transplantation in the treatment of chronic foot ulcers with soft tissue defects in patients with type 2 diabetes mellitus (T2DM) and osteoporosis.
Methods:
We retrospectively analyzed 56 patients with T2DM and osteoporosis who underwent surgical treatment between January 2020 and December 2024. Treatment allocation was non-randomized and determined by the attending surgeon; no formal sample size calculation was performed. In the AB-NPWT group, 5 patients (17.2%) crossed over to receive local flap coverage as part of the staged pathway. The analysis was not adjusted for multiple comparisons. The AB-NPWT group (n = 29) and flap transplantation group (n = 27) were compared for perioperative parameters, wound healing, limb salvage, complications, and AOFAS scores. Adjusted analyses (multivariable regression and propensity score matching) were performed to account for potential confounding.
Results:
Operative time and blood loss were significantly lower in the AB-NPWT group (both p < 0.001). At 12 months, complete wound healing (86.2% vs. 88.9%, p = 0.754), limb salvage (93.1% vs. 92.6%, p = 1.000), and median healing time (126 vs. 112 days, p = 0.221) did not differ significantly between groups. Complication rates were similar (24.1% vs. 33.3%, p = 0.446), but profiles differed. AOFAS scores at final follow-up were comparable (72.5 ± 10.3 vs. 75.8 ± 11.6, p = 0.270).
Conclusions:
In this retrospective exploratory cohort, no statistically significant between-group differences were detected in the main clinical outcomes. AB-NPWT was associated with reduced surgical trauma, whereas flap transplantation provided definitive coverage in a single operative session after debridement. Treatment selection should be individualized based on wound characteristics, patient systemic status, and healthcare resources. These findings are hypothesis-generating and require confirmation in larger prospective trials.
