Histopathological Analysis from Proximal Bone Samples During Minor Amputations for Diabetes-related Foot Infections: A Single-center, Retrospective Study.

IF 1.3 4区 医学 Q2 Medicine
Henco Nel, Lucy Stopher, Joseph Hanna, Laurens Manning, Shirley Jansen, Thomas Gliddon
{"title":"Histopathological Analysis from Proximal Bone Samples During Minor Amputations for Diabetes-related Foot Infections: A Single-center, Retrospective Study.","authors":"Henco Nel, Lucy Stopher, Joseph Hanna, Laurens Manning, Shirley Jansen, Thomas Gliddon","doi":"10.1053/j.jfas.2025.08.014","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Minor amputations, defined as resection of bone below the ankle, are important procedures for managing diabetes-related foot infections (DFI). The optimal method to determine the presence of residual bone infection is unclear and unplanned reoperation rates are common. Although international guidelines endorse the use of histopathology, this approach has not been universally adopted.</p><p><strong>Purpose: </strong>We evaluated the utility of histopathological analysis from samples collected from 'proximal' or 'marginal' bone during minor amputations.</p><p><strong>Study design: </strong>A retrospective, single-center study was conducted at Sir Charles Gairdner Hospital, in Perth, Western Australia.</p><p><strong>Methods: </strong>The primary outcome of interest was treatment success at six months, defined as being alive and no unplanned reoperation at the original operation site.</p><p><strong>Results: </strong>Of 67 cases, 22 (33%) had positive histopathology. Patients with positive margins were less likely to have treatment success compared to those with negative margins (50% versus 82%; P=0.006). Antibiotic duration was significantly shorter in patients with negative histopathological margins compared to patients with positive histopathological margins (median 14 vs 42 days; P=0.0003). The concordance between histopathology and microbiology was 51%.</p><p><strong>Conclusion: </strong>Positive histopathology was associated with lower rates of treatment success, despite receiving longer antibiotic durations. Positive culture from the same samples were not predictive of outcome. Larger, prospective studies are needed to define optimal sampling methods and antibiotic therapy following minor amputation.</p>","PeriodicalId":50191,"journal":{"name":"Journal of Foot & Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.3000,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Foot & Ankle Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1053/j.jfas.2025.08.014","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Minor amputations, defined as resection of bone below the ankle, are important procedures for managing diabetes-related foot infections (DFI). The optimal method to determine the presence of residual bone infection is unclear and unplanned reoperation rates are common. Although international guidelines endorse the use of histopathology, this approach has not been universally adopted.

Purpose: We evaluated the utility of histopathological analysis from samples collected from 'proximal' or 'marginal' bone during minor amputations.

Study design: A retrospective, single-center study was conducted at Sir Charles Gairdner Hospital, in Perth, Western Australia.

Methods: The primary outcome of interest was treatment success at six months, defined as being alive and no unplanned reoperation at the original operation site.

Results: Of 67 cases, 22 (33%) had positive histopathology. Patients with positive margins were less likely to have treatment success compared to those with negative margins (50% versus 82%; P=0.006). Antibiotic duration was significantly shorter in patients with negative histopathological margins compared to patients with positive histopathological margins (median 14 vs 42 days; P=0.0003). The concordance between histopathology and microbiology was 51%.

Conclusion: Positive histopathology was associated with lower rates of treatment success, despite receiving longer antibiotic durations. Positive culture from the same samples were not predictive of outcome. Larger, prospective studies are needed to define optimal sampling methods and antibiotic therapy following minor amputation.

糖尿病相关足部感染小截肢患者近端骨样本的组织病理学分析:单中心回顾性研究
背景:小截肢,定义为切除踝关节以下的骨骼,是治疗糖尿病相关足部感染(DFI)的重要手术。确定残余骨感染存在的最佳方法尚不清楚,意外再手术率很常见。虽然国际指南认可使用组织病理学,但这种方法尚未被普遍采用。目的:我们评估了在轻微截肢时从“近端”或“边缘”骨采集样本的组织病理学分析的效用。研究设计:在西澳大利亚珀斯查尔斯·盖尔德纳爵士医院进行了一项回顾性、单中心研究。方法:关注的主要结果是6个月时治疗成功,定义为存活且未在原手术部位发生意外再手术。结果:67例患者中,22例(33%)组织病理学阳性。与边缘阴性的患者相比,边缘阳性的患者治疗成功的可能性更小(50%对82%;P=0.006)。与组织病理边缘阳性患者相比,组织病理边缘阴性患者的抗生素使用时间显著缩短(中位数14天vs 42天;P=0.0003)。组织病理学与微生物学的一致性为51%。结论:尽管接受较长的抗生素治疗时间,但组织病理学阳性与较低的治疗成功率相关。来自相同样本的阳性培养不能预测结果。需要更大规模的前瞻性研究来确定最佳的采样方法和轻微截肢后的抗生素治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of Foot & Ankle Surgery
Journal of Foot & Ankle Surgery ORTHOPEDICS-SURGERY
CiteScore
2.30
自引率
7.70%
发文量
234
审稿时长
29.8 weeks
期刊介绍: The Journal of Foot & Ankle Surgery is the leading source for original, clinically-focused articles on the surgical and medical management of the foot and ankle. Each bi-monthly, peer-reviewed issue addresses relevant topics to the profession, such as: adult reconstruction of the forefoot; adult reconstruction of the hindfoot and ankle; diabetes; medicine/rheumatology; pediatrics; research; sports medicine; trauma; and tumors.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信