Diabetic gangrene is a dangerous condition that has a secondary nature. The root cause of this disease is diabetes mellitus (DM), complicated by microcirculatory and neurotrophic disorders in the lower extremities. From a clinical point of view, diabetic gangrene is characterized by the appearance of tissue necrosis sites, which often forces physicians to resort to amputation. The prognosis for this condition is extremely serious. Only with timely treatment for medical care can save the affected limb. Otherwise, in addition to forced amputation, a serious complication such as sepsis with subsequent multiple organ failure and death may occur.
Based on the foregoing, it can be concluded that diabetic gangrene is an extreme form of diabetic foot. It is known that about ten percent of people suffering from diabetes mellitus face a diabetic foot. All of them are at risk of developing diabetic gangrene. Interestingly, type 2 DM almost ten times more often leads to lower extremity lesions. At the same time, the risk of developing such a complication is present from the very beginning.
A bit different picture with type 1 diabetes. Patients with this disease not only suffer much less frequently from diabetic gangrene, but also face it only a few years after the onset of the disease.
According to statistics, about ten percent of people suffering from gangrene in the background diabetes need amputation of the limb. More specifically, in developed countries, six to eight amputations are performed each year per thousand diabetic patients. However, this indicator does not take into account those situations in which only part of the foot is amputated, due to which the real numbers are much higher. Moreover, among patients with type 2 diabetes, the number of such operations is slightly higher.
At the basis of diabetic gangrene is severe diabetes mellitus. As a result of this pathological process in the peripheral vessels supplying the distal extremities, atherosclerotic plaques are formed that violate the blood flow. In addition, structural and functional changes are triggered in the vessels, characterized by thickening and delamination of the capillary membrane. The violations that occur cause the tissues to stop receiving oxygen and other nutrients in the required amount, which gradually leads to their death. There are mandatory signs indicating the occurrence of metabolic polyneuropathy.
It is customary to single out a number of predisposing factors that increase the likelihood of developing such a disease. In the first place – it is a long-term non-closable hyperglycemia. It may be due to the refusal to take glucose-lowering drugs or insulin, non-compliance with the recommendations of the doctor regarding the diet and so on. It is also customary to attribute to people at risk people who are exposed to excessive loads on the foot.
Particularly dangerous with regard to this pathology are those people who have diabetes mellitus combined with some other diseases. First of all, these are problems with the cardiovascular system. A significant role is also assigned to various disorders of the urinary system, overweight and immunodeficiency states.
Symptoms indicating diabetic gangrene
In total there are two main types of diabetic gangrene: dry and wet. They will differ slightly with concomitant symptoms and further prognosis. It has been observed that people with dry gangrene are much more likely to manage without amputation of the limb.
Dry gangrene occurs when blood circulation is disrupted slowly. However, it is characterized by the occurrence of a delimited affected area, which, as a rule, does not increase in size. Initially, symptoms such as sharp pain, a pale blue hue of the skin, a local decrease in temperature and a deterioration in sensitivity are increasing. On examination, it can be found that the focus is clearly delimited from the surrounding healthy tissue by an inflammatory rim. Over time, the skin becomes dark blue or black-brown. There is a softening of tissues and their replacement by a granulation component with the gradual formation of a scar.
Symptoms in wet gangrene are much more severe. The skin also fade, and the sensitivity disappears. In the affected area, bubbles form, inside which there is a serum fluid. There is a fairly rapid increase in edema. It is impossible to determine the boundary between healthy tissues and the focus, and necrosis is rapidly spreading to the proximal sections. The affected tissues are distinguished by a testy consistency and fetid odor. There is a mandatory general intoxication of the body.
Diagnosis and treatment of the disease
Diagnosis of this disease begins with an objective examination. Additionally spend biochemical a blood test that will allow you to identify elevated levels of glucose, cholesterol and some other indicators. From instrumental methods, Doppler ultrasound, radiopaque angiography, magnetic resonance imaging of the foot are shown.
When hospitalizing for diabetic gangrene, it is first necessary to normalize glucose levels. In parallel, the correction of the cardiovascular system, detoxification measures and antibacterial therapy. Dry gangrene is most often treated conservatively. The affected limb is cleared of dead tissue, the application of local preparations is carried out, accelerating the cleansing of the wound and its healing. If diabetes is complicated by wet gangrene, surgical intervention should be performed. Its volume is selected depending on the area of destruction.
Prevention of the development of gangrene in diabetes
The main method prophylaxis is a careful monitoring of their condition in diabetes. It is necessary to comply with all the recommendations of the doctor and timely take medications aimed at combating hyperglycemia.