The role of Cerament® (Antibiotic impregnated bone void filler) in lower limb salvage for diabetic foot patients with osteomyelitis, a scoping review.

Background: Diabetic foot osteomyelitis (DFO) is a principal cause of non-traumatic lower limb amputation, contributing substantially to morbidity, healthcare costs, and reduced quality of life. Salvage optimization strategies have included the use of local antibiotic carriers to promote healing and reduce infection recurrence. Cerament, either G (gentamicin) or V (vancomycin), resorbable antibiotic-loaded bone graft substitute, has shown potential, but evidence has not been systematically mapped.

Objective: This scoping review aimed to map and summarize the available literature on the role of Cerament G and V in lower limb salvage among patients with DFO.

Methods: A systematic search of PubMed, Embase, the Cochrane library, and Google scholar [December 2024]. Studies reporting outcomes of Cerament G or V in the management of DFO were eligible. Data were charted according to PRISMA-ScR guidelines, focusing on study design, intervention details, and key findings.

Results: A total of 20 studies were identified, including [case reports, case series, retrospective reviews, and prospective cohorts]. Population within the studies ranged from 1 to 136. Reported outcomes included wound healing, eradication of infection, weight bearing, new bone formation and high antibiotic concentration without systemic toxicity. Amputation rates ranged from 2.6 % to 25 %. Evidence is limited by small sample sizes, heterogeneity in outcome reporting, and lack of randomized controlled trials.

Conclusion: Current evidence suggests that Cerament G and V may be safe and effective adjuncts for limb salvage in DFO, but high-quality comparative studies are lacking. Further research is needed to support its broader use in daily practice.