Staged antibiotic-loaded cement-based reconstruction versus flap-based reconstruction for complex diabetic foot defects in patients with osteoporosis: a retrospective cohort study.

Objective: This retrospective cohort study aimed to compare the clinical efficacy and safety of a staged antibiotic-loaded bone cement combined with negative pressure wound therapy (AB-NPWT) pathway vs. flap transplantation in the treatment of chronic foot ulcers with soft tissue defects in patients with type 2 diabetes mellitus (T2DM) and osteoporosis. Methods: We retrospectively analyzed 56 patients with T2DM and osteoporosis who underwent surgical treatment between January 2020 and December 2024. Treatment allocation was non-randomized and determined by the attending surgeon; no formal sample size calculation was performed. In the AB-NPWT group, 5 patients (17.2%) crossed over to receive local flap coverage as part of the staged pathway. The analysis was not adjusted for multiple comparisons. The AB-NPWT group ( Results: Operative time and blood loss were significantly lower in the AB-NPWT group (both Conclusions: In this retrospective exploratory cohort, no statistically significant between-group differences were detected in the main clinical outcomes. AB-NPWT was associated with reduced surgical trauma, whereas flap transplantation provided definitive coverage in a single operative session after debridement. Treatment selection should be individualized based on wound characteristics, patient systemic status, and healthcare resources. These findings are hypothesis-generating and require confirmation in larger prospective trials.