Revolutionary Flowable Gentamicin: Calcaneal Osteomyelitis Does Not Need to End in Below Knee Amputation

Introduction: Osteomyelitis of the calcaneus is a leading cause of below-knee amputations and requires urgent attention and intervention. A new product is making significant strides in transforming the treatment of osteomyelitis infections. Instead of resorting to radical debridement or below-knee amputation, a flowable gentamicin antibiotic-based bone graft* is being successfully injected to treat these infections. In this study, we aim to demonstrate that healing can be achieved even in complex cases. Methods: This case series involved five diabetic patients with multiple comorbidities and heel ulcers complicated by osteomyelitis. All under- went surgery with an injection of gentamicin-based flowable bone graft*. After the procedure, patients were monitored in an outpatient setting with regular dressing changes, and imaging studies were conducted at various stages: before surgery, during, and at healing. Some patients received multiple injections throughout their treatment. Results: The study aims to evaluate whether bone injections of antibi- otics could serve as an effective curative treatment for osteomyelitis. All five patients demonstrated resolution of their osteomyelitis and returned to full weight-bearing status upon healing. Notably, three of these patients were initially offered amputation as their first-line treatment option. Discussion: It is crucial that we explore new approaches to treating osteomyelitis. By employing this innovative surgical technique, we successfully prevented amputation in five patients with difficult-to-heal calcaneal osteomyelitis. This is a promising new approach that warrants further research.