title: Consensus on surgical aspects of managing osteomyelitis in the diabetic foot.
abstract: BACKGROUND
  The aim of this study was to develop consensus statements that may help share or even establish 'best practices' in the surgical aspects of managing diabetic foot osteomyelitis (DFO) that can be applied in appropriate clinical situations pending the publication of more high-quality data.
  
  
  METHODS
  We asked 14 panelists with expertise in DFO management to participate. Delphi methodology was used to develop consensus statements. First, a questionnaire elicited practices and beliefs concerning various aspects of the surgical management of DFO. Thereafter, we constructed 63 statements for analysis and, using a nine-point Likert scale, asked the panelists to indicate the extent to which they agreed or disagreed with the statements. We defined consensus as a mean score of greater than 7.0.
  
  
  RESULTS
  The panelists reached consensus on 38 items after three rounds. Among these, seven provide guidance on initial diagnosis of DFO and selection of patients for surgical management. Another 15 statements provide guidance on specific aspects of operative management, including the timing of operations and the type of specimens to be obtained. Ten statements provide guidance on postoperative management, including wound closure and offloading, and six statements summarize the panelists' agreement on general principles for surgical management of DFO.
  
  
  CONCLUSIONS
  Consensus statement on the perioperative management of DFO were formed with an expert panel comprised of a variety of surgical specialties. We believe these statements may serve as 'best practice' guidelines until properly performed studies provide more robust evidence to support or refute specific surgical management steps in DFO.
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Sachin
authors.initials: S
authors.lastname: Allahabadi
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Kareem B
authors.initials: KB
authors.lastname: Haroun
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Musher
authors.affiliation: Department of Medicine, University of Washington, Seattle.|Department of Medicine (Infectious Diseases), University of Geneva, Geneva, Switzerland.|Department of Medicine, Green Templeton College, University of Oxford, Oxford, United Kingdom.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine / Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; nbarshes@bcm.tmc.edu.
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
keywords: Delphi methodology; consensus; diabetes; diabetic foot; foot infection; foot ulcer; forefoot; osteomyelitis