Negative-pressure wound therapy in the management of diabetic Charcot foot and ankle wounds

Abstract

As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negative-pressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot foot and ankle wounds.

Keywords: Charcot foot; diabetes mellitus; external fixation; negative-pressure wound therapy; neuropathy; plastic surgery.

Fig. 1

Pre-operative anteroposterior (A) and lateral (B) radiographic views showing the initial presentation of a diabetic Charcot foot with abscess and osteomyelitis. Patient underwent an initial surgical debridement and bone biopsy that was followed by revisional osseous and soft tissue debridement, application of non-biodegradable cemented antibiotic beads and negative-pressure wound therapy 2 days after the initial operation (C, D). The negative-pressure wound therapy was discontinued on post-operative day 6 followed by local wound care dressing changes. At approximately 10 weeks, the patient underwent removal of the non-biodegradable cemented antibiotic beads that was followed by a medial column arthrodesis, allogenic bone grafting and application of a circular, external fixation device for compression and surgical off-loading (E–I). The external fixator was removed at approximately 6 weeks that was followed by local wound care, further lower extremity casting, immobilization, and weight-bearing status with accommodative bracing. Final clinical (J, K) and radiographic (L, M) views at approximately 23 months follow-up.