* Contact e-mail: porimed@abv.bg 1

CONTEMPORARY SILVER DRESSINGS IN THE TREATMENT

OF INFECTED BONE DEFFECTS IN NEUROPATHIC DIABETIC

FOOT (NDF)Ivan Poromanski*, Yordan Milev

Aim: To evaluate the use of different types of silver coated

dressings in the management of cavitary wounds after bone

resection for infected NDFUMHATEM N.I.Pirogov, Clinic of Septic Surgery, Sofia, Bulgaria

2

Diabetic foot ulcer

● Most common initial sign of diabetic foot

● Location – weigth bearing points – under I and V metatarsal heads ( or elseware if deformity allready exists)

● Often associated with underlying osteomyelitis

● Successful treatment requires bone infection sanation by :

Metatarsal head resection/ metatarsophalangeal joint resection => infected bone deffect

IF presence of ischaemia OR extensive soft tissue destruction

Yes NoAmputation

3

Management of infected bone defect – challenging and costly task

● Systemic antibiotic treatment – for longer periods – costly

● Closed irrigation/aspiration drainage – requires inpatient treatment

● Topical antibiotic – PMMA beads – limited space

● Negative pressure therapy – relatively contraindicated, costly

● Topical antiseptic treatment

– Jodine based (cytotoxic)

– Silver based - proven safe for soft tissues, flexible (variety of products available), cost effective

4

Case 1: M, 62 y.o., DM type 2 for 7 yD0 D5 D17 D35

Case 2: M, 39 y.o., DM type 2 for 12 yD 14 D42

5

Results and discussion● At operation plantar ulcer was excised and sutured or left. Joint was

resected via side access.

● Residual bone deffect was filled using silver coated alginate/foam dressing in 2 cases and silver alginate filler in one case

● Dressings were changed at intervals 48-72 hours; standart offloading was performed

● Systemic antibiotic use was no more than 10 days, determined of subsiding of soft tissue infection

● Cavitary wounds healed by secondary intention in no more than 42 days; plantar ulcers healed in 14-21 days

● Healing time and length of antibiotic treatment were shorter than usual, when using conventional measures

● Higher unit prise of silver dressings was well balanced by reduced frequency of dressing change and shorthened treatment course.