Table 4.

Consensus statements for postoperative management of diabetic forefoot osteomyelitis

Item	Statement	Mean rating
C-1	Delayed primary closure should be attempted at the final/definitive operation if no residual deep soft tissue infection or necrosis remains and if the residual soft tissue envelope allows tension-free reapproximation of soft tissue over bone.	7.86
C-2	Negative pressure wound therapy dressings are recommended for large soft tissue defects that remain after the final operation for cases in which delayed primary closure is not possible.	7.00
C-3	Autogenous skin grafting is the preferred method of reepithelialization for large epithelial defects when a healthy wound bed is present.	7.29
C-4	Absorbent, non-adherent dressings can be used as an alternative for soft tissue defects that remain after the final operation for cases in which delayed primary closure is not possible and negative pressure wound therapy is not available.	7.21
C-5	Offloading is important to optimize the likelihood of wound healing in the early postoperative period.	8.71
C-6	All patients who have undergone surgery for DFO should be provided with offloading footwear.	8.71
C-7	A removable cast walker (i.e. calf-height fixed-ankle walker) or a posterior splint is the preferred offloading modality following surgery for forefoot DFO.	7.07
C-8	Open-toed shoes with multidensity inserts may be used in select cases following surgery for osteomyelitis of a single toe or those with only dorsal foot wounds.	7.57
C-9	Rollator walkers, crutches, or canes should be made available for additional balance/support during ambulation.	8.14
C-10	Prolonged (6+ weeks) of postoperative antibiotic treatment is indicated after bone resection for DFO if the margin specimen shows an inflammatory cell infiltrate on histopathology and has organisms identified on culture (i.e. positive pathology and positive microbiology).	7.14

DFO, diabetic foot osteomyelitis.