title: The role of early surgical debridement and revascularization in patients with diabetes and deep foot space abscess: retrospective review of 106 patients with diabetes.
abstract: One hundred-six patients underwent emergency debridement of a deep foot space abscess. While 43 patients were admitted after an outpatient visit with immediate surgical debridement (group A), 63 patients were transferred from other hospitals after a mean stay of 6.2+/-7.5 days without debridement (group B). No significant differences were observed in the demographic and clinical features between the 2 groups, except for the following differences in group B: higher blood glucose level on admission (P=.015), lower serum albumin level (P=.005), and a more frequent extension of the infection to the heel (P=.005). Eradication of the infection was obtained in group A without amputation in 9 patients, with an amputation of 1 or more rays in 21, with metatarsal amputations in 12, and with a Chopart amputation in 1. In group B, incision and drainage alone were performed in 4 patients, amputation of 1 or more rays in 21, metatarsal amputations in 10, Chopart amputations in 23, and an above-the-ankle amputation in 5. The amputation level was significantly more proximal in group B (chi2=24.4, P<.001). There was no significant difference in the presence of peripheral arterial occlusive disease between the 2 groups (P=.841). Regression logistic analysis showed a significant relationship between the amputation level and the number of days elapsed before debridement (odds ratio, 1.61; P=.015; confidence interval, 1.10-2.36), but not with the presence of peripheral occlusive disease (odds ratio, 1.73; P=.376; confidence interval, 0.29-15.3). These data show that a delay in the surgical debridement of a deep space abscess increases the amputation level. Accuracy in the diagnosis of peripheral occlusive disease and immediate revascularization yield similar outcomes in patients with or without peripheral occlusive disease.
authors.affiliation: Diabetology Unit-Diabetic Foot Center, IRCCS Policlinico Multimedica, Sesto San Giovanni, Milan, Italy. ezio.faglia@multimedica.it
authors.forename: Ezio
authors.initials: E
authors.lastname: Faglia
authors.forename: Giacomo
authors.initials: G
authors.lastname: Clerici
authors.forename: Maurizio
authors.initials: M
authors.lastname: Caminiti
authors.forename: Antonella
authors.initials: A
authors.lastname: Quarantiello
authors.forename: Michela
authors.initials: M
authors.lastname: Gino
authors.forename: Alberto
authors.initials: A
authors.lastname: Morabito
mesh_terms: D000038:Abscess / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D000671:Amputation, Surgical; D000890:Anti-Infective Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D017719:Diabetic Foot / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000890:Anti-Infective Agents