Peripheral Arterial Disease (PAD) Expert Forum
How to prevent amputation in osteomyielitis case?
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How to prevent amputation in osteomyielitis case?

A relative is facing amputation. They're talking of cutting the 4 smaller toe

She has osteomyelitis and cellulitis in one foot. Antibiotics have been unsucessful and according to the docs she waited too long for an operation (they say it could have been a simple removal of bone without amputation, a while ago).
The case is about 8 months old now - from start of 1st symptoms.
She still responds to antibiotics. Soft tissues became a bit better after a few days of hospitalization (she was to undergo surgery but didn't know it would involve amputation...)

So, I've searched for alternatives. I've found something called the 'circulator boot', a device that uses compression, timed with the diastolic phase of the heart beat, etc, to increase blood flow to legs and feet

They give this in combination with antibiotics and other substances. In the boot the foot is soaked in sea salts (?).
Not enough solid studies, from what I read somewhere, but they (practicionner John Filip MD of Bryn Mawr wound and vascular center and a certain R. Dillon)) say they have 15 - 20 years of success with this modality.

www.circulatorboot.com

There's also art assist, a compression device you use at home, more researched than the first one. Both claim to prevent amputations in cases where traditional medicine would have failed.

Do you know of a surer way of treating this, or are these therapies sufficiently trustworthy?
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Hi Mike
How are you? Kudos for doing a lot of research. Osteomyelitis, as you know, is infection of the bone. In most cases when osteomyelitis exists, it impairs the ability of overlying soft tissue to heal. If the tissue does heal, the chance of recurrent infection is very high.
Generally speaking the usual treatment for osteomyelitis is removal of the infected bone, closure with healthy tissue and a course of antibiotics directed at the causative agent.

The second part of treatment involves assessment of the blood flow. Reasonable blood flow to the area of involvement is necessary to heal as well. Your note inquires about the use of several arterial circulation assist devices. Generally speaking, these devices are reserved for individuals that have anatomy that is not amenable to some intervention to improve blood flow(ie angioplasty, stent, bypass and others). It is also used in individuals that have medical conditions that prevent the safe conduct of an operation to improve circulation

The results of the devices are variable in the medical literature. Althouh I am director of The Penn Woundcare system of The University of Pennsylvania, we have not seen a role for this therapy. I would however encourage you to investigate use of the device further if the circumstances preventing a procedure to improve blood flow are present.

I would also suggest that you speak directly to the physicians caring for your relative as they may be able to walk you through the line of thinking that has lead them to this point. good luck
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Thank you for your answer!

The patient was told that a bypass should only be considered a last resort, that her circulation, while bad, didn't warrant such intervention until other treatments had been tried. They said they thought her circulation was "good enough" to do without a bypass.

However, I noticed the sequence of treatment you mentioned: 1. Removal of infected bone.  2. Closure with healthy tissue.  3. Antibiotics

The specialists who treated her did: 1. Antibiotics (to 'avoid an intervention if possible") and then surgery (to remove infected bone) was considered, upon the antibiotic treatment's failure.

After the antibiotics treatment was stopped, the specialists told us that antibiotics have a hard time reaching bone tissue. We didn't get much information at first. Nothing about the last point.
Had we known, we would have opted for surgery at the beginning, while the amount of infected bone was small and amputation could easily be avoided.

I am not a specialist but I doubt the judgement of the specialists involved. If they knew that antibiotics by themselves have a hard time reaching bones and even more in people with poor blood circulation, why not strongly suggest performing bone surgery at the outset?

That and a few other, relatively minor, things on their part has shaken a bit my trust in them.

Including as to whether there is really no other alternative to amputation. She was released from hospital yesterday, the micobiologist treating her not seeming alarmed at the idea of her trying out some of those alternative methods and scheduling a visit in one month's time.

Sometimes I wonder what the truth is in all of this? We're urged to go for the operation, as soon as possible, then they are rather 'cool" (not alarmed) with us trying something else for a while?

??

But thanks again for your answer!
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