Saturday, August 27, 2016

Diabetic gangrene

In 1852, Marchal de Calvi first recognized the association between gangrene and diabetes and he suggested a causal relationship between diabetes and peripheral nerve damage. Diabetes mellitus, if severe and poorly controlled, may result in infective gangrene of the foot.

Diabetic gangrene is a complication of diabetes, causing the tissue to die. As the condition progresses amputation of the affected is the traditional course of action. This results from a combination of diabetic microangiopathy, with subintimal arteriolar thickening producing vascular impairment, an increased susceptibility to tissue infection as a result of reduced host defences, and an associated peripheral neuropathy, which renders the soft tissues more susceptible to trauma.

Due to sensory neuropathy, minor injuries are not notice and so infection occurs. Due to motor neuropathy, dysfunction of muscles arches of foot and joints, loss of reflexes of foot occurs causing it more prone to trauma, abscess, etc.

Due to autonomic neuropathy, skin will be dry, causing defective skin barrier also more prone to infection. Diabetic atherosclerosis itself reduces the blood supply and causes gangrene. Thrombosis can be precipitated by infection causing infective gangrene.

The gangrene is treated by drainage of pus, debridement of dead tissue with local amputation of necrotic digits and antibiotics.
Diabetic gangrene

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