Speakers - 2025

Biography

Mr. Randhir Francis is a highly skilled trauma and orthopedic surgeon working at Guy’s and St. Thomas’ NHS Foundation Trust, specializing in foot and ankle surgery. He has a sub-specialty interest in the management of foot osteomyelitis, working closely with the Diabetic Foot Multidisciplinary Team, including infectious diseases, diabetes, and podiatry. 

Abstract

Introduction

The incidence of calcaneal osteomyelitis is increasing in tandem with the prevalence of predisposing conditions, such as diabetes and peripheral vascular disease.

Due to the difficulties surrounding calcaneal infection and ulcer management, the usual treatment is often a below-knee amputation.

We at Guy’s and St Thomas’ Hospital have trialed the combination of surgical debridement with insertion of Cerament bone void filler to deliver antibiotics locally as well as fill dead space.

Objectives:

To assess whether or not combining Cerament bone void filler with surgical debridement to treat calcaneal osteomyelitis enables limb salvage.

Methods:

A retrospective review of 15 patients over a period of 4 years who underwent calcaneal surgical debridement by a single surgeon and insertion of Cerament containing vancomycin and gentamicin was undertaken. 

The patients had been reviewed weekly until improvement was seen by a multidisciplinary team with staff from orthopedics, infectious diseases, podiatry, and diabetes. Negative pressure dressings and podiatry debridement were used in conjunction. The primary goal was to achieve wound closure and avoid recurrence once antibiotics or antifungals were discontinued in order to enable limb salvage.

Results:

Of the 15 eligible patients who had the procedure over a 4-year period, three patients’ heel ulcers have healed and no longer require antibiotics; 7 have residual ulcers that require Podiatry input but are no longer taking antibiotics and have avoided amputation; 2 have required below-knee amputations; 3 have unfortunately died due to multimorbidity.

In total, 10 out of 15—66% of patients—have avoided below-knee amputation. 

Conclusion:

A combination of cerament bone void filler with surgery provides an exciting prospect for limb salvage in this difficult-to-manage condition with a salvage rate of 66%.