Infected Bone is Dead and Must be Removed
It is actually simple: an inflammation is a reaction of living tissue to a damaging process in order to limit its spread and repair the consequences. What is inflamed cannot be dead and what is dead cannot be inflamed. This makes the common idea that infected bone can be regarded as dead and should always be removed, including amputation if necessary, all the more incomprehensible.
Amputation avoidance: Differentiating infected bone from dead bone
The treatment of people with DFS is intended to ensure their survival and maintain their mobility. The avoidance of amputations is of essential importance. If the frequency of amputations is considered to be too high, concepts that substantiate amputation must be questioned. In interdisciplinary amputation prevention, the strict separation of inflamed and necrotic bones has been considered a useful concept. In this view, operations in which something is removed only aim at the elimination of dead bone plus unavoidable components in the surrounding area. The goal is a resilient foot. However, there is a widespread but false belief that all infected bones must be removed as if we were still in a preantibiotic period. There are probably countless unnecessary amputations to blame due to this wrong concept. Any automatisms leading to amputation should be replaced by differentiated strategies. Decision making should be based on criteria similar to those of an infected endoprosthesis, e.g. a knee endoprosthesis.
MRI images exaggerate and lag behind recovery for a long time
In view of this tradition, it is particularly unfortunate that modern imaging methods such as MRI represent more nuances than doctors from earlier times are used to find. In these pictures, broader parts appear inflamed. These repair processes can still be seen for a long time, even if the affected person already feels completely recovered. Those doctors who feel stuck in the traditional view and want to remove all inflamed bones could cut off even more in this constellation than had already been unnecessarily planned anyway.
It is therefore particularly important to obtain a second opinion from experienced physicians who are economically independent from the amputating facility before each amputation, even if it appears to be a ‘minor’ one.