• Efstathios Drampalos, Hasan Raza Mohammad, Chris Kosmidis, Moez Balal, Jason Wong, and Anand Pillai.
• Trauma and Orthopaedics Department, Wythenshawe Hospital, Manchester, United Kingdom. Electronic address: Efstathios.Drampalos@uhsm.nhs.uk.
• Foot (Edinb). 2018 Mar 1; 34: 40-44.

BackgroundChronic osteomyelitis necessities appropriate infected bone and soft tissue excision. The authors describe the Silo surgical technique for the treatment of calcaneal osteomyelitis using a new antibiotic-loaded absorbable calcium sulphate/hydroxyapatite biocomposite.MethodsThe Silo method involves debridement of the dead bone and local delivery of antibiotic in drilled tunnels using the biocomposite. It is combined with multiple sampling and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. Twelve consecutive diabetic patients with heel ulcers and calcaneal osteomyelitis were treated with the above method. All had comorbidities (Cierny-Mader (C-M) Class B hosts). The mean age was 68 years (range 50-85). A retrospective review of radiographs and electronic medical records was conducted.ResultsPatients were followed up until clinical cure of the ulcer for a mean of 16 weeks (range 12-18). Infection was eradicated in all 12 patients with a single stage procedure following a bone preserving technique. One patient required a subsequent flap operation and six vacuum-assisted closure (V.A.C.). There was also one case of prolonged wound leakage and no calcaneal fractures.ConclusionsThe Silo technique is an effective method of local delivery of antibiotics and can be effectively implemented into the single-stage treatment of calcaneal osteomyelitis offering increased bone preservation and local delivery of antibiotic, decreasing the need for a major amputation.Level Of EvidenceLevel IV- case series.Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

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