Vascular Insufficiency and Osteomyelitis of the Lower Extremity

Abstract

Osteomyelitis secondary to peripheral vascular insufficiency was evaluated in forty-six males. A control group of sixteen did not receive antibiotics; the remainder received Cephalothin pre- and post-operatively. An equal number of patients in both groups had diabetes mellitus. Based on x-ray and clinical findings, all patients underwent local amputation. Staphylococcus aureus was the most common organism recovered. Thirty-seven percent of the non-antibiotic treated group required further revision to a higher level of amputation.

The most frequent cause of amputation of the lower extremity is atherosclerosis, complicated by diabetes mellitus and infection.² Progression of the primary disease process often results in ulceration, sepsis, gangrene and osteomyelitis. The responsible surgeon must not "whittle" nor must he be too aggressive. Evaluating the rehabilitation potential of each individual, and being aware of the disability incurred by amuputation, "selective conservatism" is the key. This study demonstrates the selected salvage of the lower extremity by limited amputation and long term antibiotic therapy.