Association of modified revascularizing osteotrepanation with early in-hospital outcomes in patients with distal neuroischemic diabetic foot syndrome

Objective: to assess the association of modified revascularizing osteotrepanation with early in-hospital treatment outcomes in patients with distal neuroischemic diabetic foot syndrome.

Methods: a single-center comparative study included 44 patients followed up until hospital discharge. The main group comprised 22 patients who underwent modified revascularizing osteotrepanation as part of comprehensive treatmentwhen direct revascularization was not feasible. The control group included 22 patients treated without osteotrepanation. Continuous data are presented as Me [Q1-Q3] and categorical data as n (%). Between-group comparisons were performed using the Mann-Whitney U test and Fisher exact test.

Results: time to granulation tissue appearance was shorter in the main group: 9.6 [8.3-12.5] days versus 20.9 [17.3-23.8] days, p<0.001. Length of hospital stay was also shorter: 20.8 [17.1-22.4] days versus 32.7 [29.4-37.9] days, p<0.001. Any amputation was performed in 14 of 22 patients in the main group and in all 22 control patients: 63.6% versus 100.0%, p=0.004; relative risk of amputation was 0.64 (95% CI 0.46-0.87). The proportion of patients discharged alive without amputation was 22.7% versus 0%, p=0.048. Positive wound dynamics was observed in 36.4% and 4.5% of patients, respectively, p=0.021. In-hospital mortality did not differ significantly: 13.6% versus 22.7%, p=0.698.

Conclusion: in patients with distal neuroischemic diabetic foot syndrome, modified revascularizing osteotrepanation was associated with earlier granulation tissue formation, shorter hospital stay, and a lower amputation rate before discharge. These findings should be interpreted with caution given the small sample size, single-center design, and baseline differences in Wagner grade distribution.

1. Armstrong D.G, Tan T.W, Boulton AJ.M, Bus S.A. Diabetic foot ulcers: a review. JAMA. 2023;330(1):62-75. http://doi.org/10.1001/jama.2023.10578

2. Lazzarini P.A, Cramb S.M, Golledge J, Morton J.I, Magliano D.J, van Netten J.J. Global trends in the incidence of hospital admissions for diabetes-related foot disease and amputations: a review of national rates in the 21st century. Diabetologia. 2023;66(2):267-287. http://doi.org/10.1007/s00125-022-05845-9

3. Jeffcoate W, Boyko E.J, Game F, Cowled P, Senneville E, Fitridge R. Causes, prevention, and management of diabetes-related foot ulcers. Lancet Diabetes Endocrinol. 2024;12(7):472-482. http://doi.org/10.1016/S2213-8587(24)00110-4

4. Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt CA, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev. 2024;40(3):e3686. http://doi.org/10.1002/dmrr.3686

5. Senneville E, Albalawi Z, van Asten S.A, Abbas Z.G, Allison G, Aragón-Sánchez J, et al. IWGDF/ IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF/IDSA 2023). Diabetes Metab Res Rev. 2024;40(3):e3687. http://doi.org/10.1002/dmrr.3687

6. Bus S.A, Armstrong D.G, Crews R.T, Gooday C, Jarl G, Kirketerp-Møller K, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3647. http://doi.org/10.1002/dmrr.3647

7. Monteiro-Soares M, Hamilton E.J, Russell D.A, Srisawasdi G, Boyko EJ, Mills J.L, et al. Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3648. http://doi.org/10.1002/dmrr.3648

8. Nabiev M.Kh., Abdulloev J.A., Khafizov B.M. Comprehensive assessment and correction of the state of the blood coagulation system in patients with diabetic foot syndrome. Healthcare of Tajikistan. 2017;3:55-61. (In Russ.)

9. Nabiev M.Kh., Yusupova Sh.Yu., Saykhunov K.D., Boronov T.B. Prevention of purulent complications in patients with diabetic foot syndrome. Bulletin of postgraduate education in healthcare. 2017;4:69-72. (In Russ.)

10. Petersen B.J, Linde-Zwirble W.T, Tan T.W, Rothenberg G.M, Salgado S.J, Bloom J.D, et al. Higher rates of all-cause mortality and resource utilization during episodes-of-care for diabetic foot ulceration. Diabetes Res Clin Pract. 2022;184:109182. http://doi.org/10.1016/j.diabres.2021.109182

11. Dua A, Powell R.J, Lee AC, Bernardo N, Mills JL, Ferrer Cardona L, et al. Contemporary outcomes in no-option chronic limb-threatening ischemia. Sci Rep. 2025;15(1):24446. http://doi.org/10.1038/s41598-025-09784-4

12. Wen Y, Chen L, Lan J, Li L. Efficacy of tibial cortex transverse transport in treating diabetic foot ulcer and its effect on serum omentin-1 and irisin levels. DiabetolMetab Syndr. 2024;16(1):154. http://doi.org/10.1186/s13098-024-01400-1