Effect of Induced Membrane Formation Followed by Polymethylmethacrylate Implantation on Diabetic Foot Ulcer Healing When Revascularization Is Not Feasible

Figure 1

The two-staged surgical protocol for the polymethylmethacrylate (PMMA) group: (a) a 74-year-old male patient with diabetic foot ulceration (Wagner grade 4) in the right foot; (b) computed tomography angiography indicated peripheral arterial disease and revascularization surgery failed owing to calcific disease in the distal vasculature; (c) plain radiography showed osteomyelitis on the third, fourth, and fifth toes and corresponding metatarsal bones; (d) the nonviable, infected soft tissues and necrotic toes were debrided during the initial procedure; (e) the defect created by debridement was filled with vancomycin-loaded PMMA; (f) plain radiography showed the PMMA spacer at 3 days; (g) the block of the PMMA spacer was carefully exposed and removed after 3 weeks; (h) the intact induced membrane was a thin, semitransparent pseudosynovial membrane during the second procedure; (i) the ulcer was completely healed without signs and symptoms of osteomyelitis at follow-up.

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