What if your next diabetic foot osteomyelitis case could include a tool that delivers high-local antibiotic concentrations and fills dead-space in the same step? For orthopaedic surgeons managing complex diabetic foot infections, STIMULAN® (calcium-sulfate beads) may offer exactly that — not as a silver bullet, but as a strategic adjunct.
Clinical context
Diabetic foot osteomyelitis (DFO) is a major challenge in orthopaedics — polymicrobial biofilms, impaired perfusion, dead-space after debridement, and high rates of recurrence complicate surgical success. Local antibiotic delivery has therefore emerged as an adjunctive strategy. (diabeticstudies.org)
What the Product offers
STIMULAN is a resorbable calcium-sulfate matrix that can be loaded intraoperatively with antibiotics selected per culture. It can fill bone voids or soft-tissue dead-space while eluting high local antibiotic concentrations. In vitro data show inhibition of polymicrobial diabetic foot infection strains with zones of inhibition of 15-40 mm using vancomycin/gentamicin loaded beads. (microbiologyresearch.org)
Evidence summary
- A retrospective review of 19 patients with Wagner Grade 3-4 diabetic foot ulcer + osteomyelitis treated with STIMULAN reported 84% complete healing at 1-month and 0% amputations at 24 months. (Thieme)
- A cohort study of diabetic osteo-articular infections treated with CaSO₄ beads achieved a 92% eradication rate but also reported 62% wound drainage as a safety issue. (PubMed)
- A systematic review on local antibiotic delivery systems for DFO concluded that although healing rates appear adequate in case-series, evidence remains limited, especially for amputation-reduction or randomized data. (RCA Storage)
Key considerations for orthopaedic practice
- Patient selection: STIMULAN should be considered when adequate surgical debridement is achieved and dead-space management is required.
- Antibiotic loading: Culture-guided antibiotics must be selected for mixing; systemic therapy remains essential.
- Dead-space management: Use STIMULAN to fill bone/soft tissue cavities created by debridement — it is not a substitute for surgical clearance.
- Safety & drainage: Be aware of wound drainage—studies report rates of up to 60% in foot osteomyelitis settings. Monitoring and appropriate wound care are crucial. (PubMed)
- Cost-effectiveness & long-term outcome: While promising, definitive data on limb salvage, recurrence prevention, and cost-benefit are still lacking.
Conclusion
For orthopaedic surgeons treating diabetic foot osteomyelitis, STIMULAN offers a biologically plausible, technically feasible adjunct: a resorbable antibiotic carrier that addresses dead-space and delivers high local antibiotic concentrations. The current data are encouraging but not definitive — STIMULAN should be integrated into multidisciplinary pathways rather than replacing standard surgical-medical care.
Selected References:
- Chatzipapas C, Karaglani M, Tilkeridis K, Drosos GI. Local antibiotic delivery systems in diabetic foot osteomyelitis. Review of Diabetic Studies 2021. (RCA Storage)
- Fletcher J, Porter R, Boulton Z, et al. In vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan®) against polymicrobial DFI communities. J Med Microbiol 2022. (microbiologyresearch.org)
- Chon H.T.W., Hamish M., Kirupananthan P., et al. STIMULAN® antibiotic beads for the treatment of diabetic foot infection. Arab J Infectious Diseases 2021. (Thieme)
