[Clinical effects of antibiotic bone cement and VSD combined with free chimeric anterolateral thigh perforator myocutaneous flaps for sequential treatment of diabetic calcaneal osteomyelitis wounds].

Stage I treatment with antibiotic bone cement filling and VSD significantly reduced white blood cell count within 7 days.

• White blood cell count decreased from 12.30 (11.28, 13.48)×10⁹/L at admission to 7.15 (6.73, 8.70)×10⁹/L at 7 days after Stage I treatment.
• Z value was -2.905, P<0.05.
• Study included 12 patients with diabetic calcaneal osteomyelitis wounds treated between June 2019 and June 2024.

Stage I treatment significantly reduced neutrophil ratio within 7 days.

• Neutrophil ratio decreased from 0.80 (0.78, 0.83) at admission to 0.65 (0.63, 0.72) at 7 days after Stage I treatment.
• Z value was -2.825, P<0.05.

Stage I treatment significantly reduced high-sensitivity C-reactive protein levels within 7 days.

• High-sensitivity C-reactive protein decreased from 73.20 (57.25, 93.75) mg/L at admission to 15.50 (12.48, 25.50) mg/L at 7 days after Stage I treatment.
• Z value was -3.059, P<0.05.

Microbial culture results converted from all positive at admission to all negative 7 days after Stage I treatment.

• At admission, microbial culture results of wound secretion specimens were all positive and redness and swelling around the wound were obvious.
• Seven days after Stage I treatment, microbial culture results were all negative, there was no obvious redness or swelling around the wound, and wound-bed granulation tissue grew well.

The majority of free chimeric anterolateral thigh perforator myocutaneous flaps survived well after Stage II surgery, with only minor complications in two patients.

• Only 2 of 12 patients had a small area of ischemic epidermal necrosis at the distal end of the flap, which healed with delayed healing after dressing changes.
• The flaps of the remaining 10 patients all survived well and wounds in the recipient areas healed smoothly.
• Donor area wounds of all 12 patients healed well.
• Perforator flap area ranged from 10.0 cm×5.0 cm to 20.0 cm×10.0 cm; muscle flap area ranged from 3.0 cm×2.5 cm to 7.0 cm×6.0 cm.

During follow-up of 6 to 18 months, no ulcer recurrence was observed and no obvious signs of osteomyelitis recurrence were found on X-ray examination.

• Follow-up duration ranged from 6 to 18 months.
• Blood supply and appearance of the flaps were good and texture was soft.
• No recurrence of ulcers was observed.
• X-ray examination showed no obvious signs of recurrence of osteomyelitis.
• Donor areas recovered well without obvious scar hyperplasia, and all affected limbs were able to perform weight-bearing activities.

The study treated patients with Wagner grade III and IV diabetic calcaneal osteomyelitis wounds using a two-stage sequential approach.

• 12 patients were included: 7 males and 5 females, aged 40 to 65 years.
• 8 cases had Wagner grade III wounds and 4 cases had Wagner grade IV wounds.
• Stage I: debridement + temporary antibiotic bone cement filling and coverage + VSD treatment; wound area after debridement was 6 cm×5 cm to 18 cm×8 cm; bone defect volume was 1.0 cm×0.8 cm×0.5 cm to 1.8 cm×1.5 cm×0.8 cm.
• Stage II: free chimeric anterolateral thigh perforator myocutaneous flap repair.
• This was a retrospective case series study.