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DIABETIC FOOT:
WHY USE CERAMENT

CERAMENT®|G and CERAMENT® V augments the management of diabetic foot

Dead space management

High local concentration of antibiotic

Remodels into bone within 6 -12 months

Foot infections and their progression are one of the most common and severe complications of diabetes mellitus. In the UK, hospitalization for diabetic patients with foot disorders is greater than all other diabetic complications combined. In the US foot infections in diabetic patients are the leading cause of lower-extremity amputations. In Germany, it has been reported that 72% of non-traumatic lower-extremity amputations are attributable to diabetes. 

In most reported series, about a third of diabetic patients who present with foot infections were found to have evidence of osteomyelitis. In nearly all studies of diabetic foot osteomyelitis, there are a number of pathogens involved, the most common being Staphylococcus aureus, followed by other aerobic gram-positive cocci and various aerobic gram-negative bacilli. 

Neuropathy, poor perfusion and non-compliance make diabetic foot infections some of the most difficult to treat. CERAMENT|G and/or CERAMENT V can help in the management of these patients by offering a high local concentration of antibiotic, irrespective of vascular perfusion profile, and complete dead space management to further reduce the risk of infection. Both products are radiopaque and injectable through a 16G needle, making them ideal for cases where access is difficult, and bone remodeling helps support bone/limb sparing surgery and reduce the risk of amputation.

REFERENCES

Lipsky BA et al. The diabetic foot. Infect Dis North Am 1990;4:409–32.

Karchmer AW & Gibbons GW. Foot infections in diabetes: evaluation and management. Curr Clin Top Infect Dis 1994;14:1–22.

Caputo GM et al. Assessment and management of foot disease in patients with diabetes. N Engl J Med 1994;331:854–60

Elkeles RS & Wolfe JHN. The diabetic foot. BMJ 1991;303:1053–5.

Connell FA et al. Lower extremity amputation among persons with diabetes mellitus—1980–1987. MMWR Morb Mortal Wkly Rep 1991;40:737–9.

Geiss LS et al. Surveillance for diabetes mellitus—1980–1987. MMWR Morb Mortal Wkly Rep 1993; 42:1–20.

Newman LG, Waller J, Palestro CJ, et al. Unsuspected osteomyelitis in diabetic foot ulcers: diagnosing and monitoring by leukocyte scanning with indium In111 oxyquinolone. JAMA 1991;266:1246–51

Pecoraro RE et al. Pathways to diabetic limb amputation. Basis for prevention. Diabetes Care. 1990;13:513–21.

Lipsky BA. Osteomyelitis of the Foot in Diabetic Patients CID 1997;25 (December)

Lipsky BA. Medical Treatment of Diabetic Foot Infections. CID 2004:39 (Suppl 2), S104–14

Nilsson et al. The composite of hydroxyapatite and calcium sulphate: a review of preclinical evaluation and clinical applications. Expert Rev. Med. Devices 10(5), 675-684, 2013

CERAMENT®|BONE VOID FILLER Bone healing technical monograph - PR 0278-01 EN

CERAMENT®|BONE VOID FILLER Instructions for Use – IFU 0004-08

CERAMENT®|G Instructions for Use – IFU 0014-02

CERAMENT®|V Instructions for use - IFU0016-02

Abramo et al. Osteotomy of dorsally displaced malunited fractures of the distal radius: No loss of radiographic correction during healing with a minimally invasive fixation technique and an injectable bone substitute. Acta Orthop 79:262-268, 2008

Bark et al. Case Report: Arthroscopic-Assisted Treatment of a Reversed Hill-Sachs Lesion: Description of a New Technique Using CERAMENT®. Case Reports in Orthopedics, Volume 2015, Article ID 789203, 5 pages. http://dx.doi.org/10.1155/2015/789203

Kaczmarczyk et al. Complete twelve month bone remodeling with a bi-phasic injectable bone substitute in benign bone tumors: a prospective pilot study. BMC Musculoskeletal Disorders (2015) 16:369. DOI 10.1186/s12891-015-0828-3

Whisstock et al. A calcium sulphate/hydroxyapatite bone graft substitute eluting gentamicin in the treatment of diabetic foot osteomyelitis: a mid-term follow-up. Orthopaedic Proceedings (2016) vol. 98-B no. SUPP 23 25

Berli et al. Antibiotic eluting bone graft substitute