{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:08:32Z","timestamp":1791389312629,"version":"4.3.3"},"reference-count":41,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T00:00:00Z","timestamp":1611014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Diabetic foot ulcers, complicated by osteomyelitis, can be treated by surgical resection, dead space filling with gentamicin-loaded calcium sulphate-hydroxyapatite (CaS-HA) biocomposite, and closure of soft tissues and skin. To assess the feasibility of this treatment regimen, we conducted a multicenter retrospective cohort study of patients after failed conventional treatments. From 13 hospitals we included 64 patients with forefoot (n = 41 (64%)), midfoot (n = 14 (22%)), or hindfoot (n = 9 (14%)) ulcers complicated by osteomyelitis. Median follow-up was 43 (interquartile range, 20\u201361) weeks. We observed wound healing in 54 patients (84%) and treatment success (wound healing without ulcer recurrence) in 42 patients (66%). Treatment failures (no wound healing or ulcer recurrence) led to minor amputations in four patients (6%) and major amputations in seven patients (11%). Factors associated with treatment failures in univariable Cox regression analysis were gentamicin-resistant osteomyelitis (hazard ratio (HR), 3.847; 95%-confidence interval (CI), 1.065\u201313.899), hindfoot ulcers (HR, 3.624; 95%-CI, 1.187\u201311.060) and surgical procedures with gentamicin-loaded CaS-HA biocomposite that involved minor amputations (HR, 3.965; 95%-CI, 1.608\u20139.777). In this study of patients with diabetic foot ulcers, complicated by osteomyelitis, surgical treatment with gentamicin-loaded CaS-HA biocomposite was feasible and successful in 66% of patients. A prospective trial of this treatment regimen, based on a uniform treatment protocol, is required.<\/jats:p>","DOI":"10.3390\/jcm10020371","type":"journal-article","created":{"date-parts":[[2021,1,19]],"date-time":"2021-01-19T11:39:55Z","timestamp":1611056395000},"page":"371","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Surgical Treatment of Diabetic Foot Ulcers Complicated by Osteomyelitis with Gentamicin-Loaded Calcium Sulphate-Hydroxyapatite Biocomposite"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4872-7693","authenticated-orcid":false,"given":"Kor H.","family":"Hutting","sequence":"first","affiliation":[{"name":"Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, Overijssel, The Netherlands"},{"name":"Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4834-1691","authenticated-orcid":false,"given":"Wouter B.","family":"aan de Stegge","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, The Netherlands"},{"name":"Department of Rehabilitation, University of Amsterdam, Amsterdam UMC, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6420-6046","authenticated-orcid":false,"given":"Jaap J.","family":"van Netten","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, Overijssel, The Netherlands"},{"name":"Department of Rehabilitation, University of Amsterdam, Amsterdam UMC, Amsterdam Movement Sciences, Meibergdreef 9, 1105 AZ Amsterdam, Noord-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter A.","family":"ten Cate","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, Overijssel, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luuk","family":"Smeets","sequence":"additional","affiliation":[{"name":"Department of Surgery, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gijs M. J. M.","family":"Welten","sequence":"additional","affiliation":[{"name":"Department of Surgery, Franciscus Gasthuis &amp; Vlietland, Kleiweg 500, 3045 PM Rotterdam, Zuid-Holland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dick M.","family":"Scharn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, Gelderland, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Paul P. M.","family":"de Vries","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff G.","family":"van Baal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Hospital Group Twente, Zilvermeeuw 1, 7609 PP Almelo, Overijssel, The Netherlands"},{"name":"Welsh Wound Innovation Centre, Rhodfa Marics, Ynysmaerdy, Pontyclun CF72 8UX, Wales, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1056\/NEJMra1615439","article-title":"Diabetic Foot Ulcers and Their Recurrence","volume":"376","author":"Armstrong","year":"2017","journal-title":"N. Engl. J. 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