Gentamicin-loaded Calcium Sulfate-hydroxyaPatite Biocomposite to tREat Diabetic Foot Ulcers Complicated by oSteomyElitis: a pRospectiVE Cohort Study

Status: Unknown
Location: See all (10) locations...
Study Type: Observational
SUMMARY

The amputation risk is high when diabetic foot ulcers, complicated by osteomyelitis, fail to heal after non-surgical standard-of-care treatment. A new treatment regimen has been developed recently and has been proven feasible. This treatment regimen consists of surgical debridement, followed by bone void filling with gentamicin-loaded calcium sulfate-hydroxyapatite biocomposite and closure of soft tissues and skin, in combination with antibiotic therapy and offloading. This treatment regimen has not been investigated prospectively. Therefore, this multicenter prospective cohort study was designed, with the primary objective of investigating postoperative wound healing. Patients with diabetic forefoot ulcers, complicated by osteomyelitis, will be included. The most relevant exclusion criteria are: Severe diabetic foot infection, severe limb ischemia, and foot deformity causing high pressure and friction on the diabetic foot ulcer. After inclusion, subjects will undergo study phase 1, which is observation of the standard-of-care non-surgical treatment. When standard-of-care non-surgical treatment is unsuccessful, subjects will be included in study phase 2, which consists of treatment by surgical debridement of the diabetic foot ulcer and underlying osteomyelitis, followed by bone void filling with gentamicin-loaded calcium sulfate-hydroxyapatite biocomposite and closure of soft tissues and skin, followed by a postoperatieve treatment regimen which involves wound care, 10 days of antibiotic therapy and offloading. The primary outcome measure of this study is the proportion of subjects with post-operative wound healing, which will be investigated clinically and will be objectified by a review panel of blinded, independent experts based on digital photographs. Follow-up will be performed until wound healing or for a maximum of 20 weeks. The primary outcome measure is the proportion of subjects with postoperative wound healing during 20 weeks of follow-up. Secondary outcome measures are: days until postoperative wound healing, proportion of subjects with persistent osteomyelitis post-operatively, proportion of subjects undergoing amputations during follow-up, foot function index scores at inclusion and after 20 weeks follow-up.

Eligibility
Participation Requirements
Sex: All
Minimum Age: 18
Healthy Volunteers: f
View:

• 18 years of age or older.

• One or multiple forefoot diabetic foot ulcers complicated by osteomyelitis. The treating physician will diagnose osteomyelitis, based on either positive culture results or histopathologic findings of a bone sample, or on the combination of clinical findings of inflammation and a positive probe-to-bone test or imaging findings (X-ray, MRI) A patient with multiple forefoot DFOs can be included as long as all ulcers are related to osteomyelitis on one location.

• Sufficient soft tissues and skin for primary closure or closure by local tissue transposition after surgical debridement, as judged by the treating physician.

• Written declaration of informed consent

Locations
Other Locations
Netherlands
Jeroen Bosch Hospital
RECRUITING
's-hertogenbosch
Hospitalgroup Twente
RECRUITING
Almelo
Rijnstate Hospital
RECRUITING
Arnhem
Reinier de Graaf Hospital
RECRUITING
Delft
Slingeland Hospital
RECRUITING
Doetinchem
St. Jansdal Hospital
RECRUITING
Harderwijk
St. Antonius Hospital
RECRUITING
Nieuwegein
Franciscus Gasthuis & Vlietland
RECRUITING
Rotterdam
Maasstad Hospital
RECRUITING
Rotterdam
University Medical Center Utrecht
RECRUITING
Utrecht
Contact Information
Primary
Kor H. Hutting, M.D.
k.h.hutting@umcg.nl
0031887084232
Time Frame
Start Date: 2022-12-01
Completion Date: 2025-01-01
Participants
Target number of participants: 182
Treatments
PRESERVE protocol
Treatment according to the PRESERVE protocol consists of 2 study phases. Phase 1 consists of standard-of-care non-surgical treatment, performed in accordance with current treatment guidelines, during which the research team performs observations.~After failed standard-of care non surgical treatment, subjects will be included in study phase 2 and undergo treatment by surgical debridement of the diabetic foot ulcer and underlying osteomyelitis, followed by bone void filling with gentamicin-loaded calcium sulfate-hydroxyapatite biocomposite and closure of soft tissues and skin, followed by postoperative treatment regimen including woundcare, 10 days of antibiotics and offloading.
Related Therapeutic Areas
Sponsors
Collaborators: St Jansdal Hospital, UMC Utrecht, Maasstad Hospital, St. Antonius Hospital, Franciscus Gasthuis, Slingeland Hospital, Reinier de Graaf Groep, Jeroen Bosch Ziekenhuis, Rijnstate Hospital, Ziekenhuisgroep Twente
Leads: University Medical Center Groningen

This content was sourced from clinicaltrials.gov