Intra-operative tissue sampling and microbiological analyses during minor lower limb amputations in patients with diabetes are poorly reported and difficult to interpret

Diabetic foot disease (DFD) is a leading cause of acute sepsis and has long-term consequences for patients. It poses a strain on health resources in both the developed and developing world, with a significant impact on patient quality of life due to the associated complications of DFD and the often multiple interventions required to control infection and preserve limb tissue. Although there is evidence in the literature regarding early detection and prompt management of this debilitating condition, there is little structured evidence on how to gain accurate tissue sampling with processing to allow targeted antimicrobial therapy from minor amputations where bone cultures have been sent. Methods: A literature review was conducted to establish the publications on intra-operative bone sampling and processing taken during diabetic foot minor amputations and the pathways described for processing sample acquisition. Findings: Thirty papers were identified which highlighted some of the processes involved in the procurement of intraoperative tissue samples. No published paper reported a complete pathway for the ascertainment of samples, transfer and processing of these specimens. Conclusion: There is no published consistent pathway published for procurement of intra-operative diabetic foot specimens, for their storage, transportation and processing. Without documented, reproducible processes, it is difficult to interpret published results. This makes planning for targeted antibiotic therapy more difficult.