Gangrene in diabetes
Gangrene is clinical anatomic form of necrosis – dead tissues in a living organism in which their functions cease completely. The term gangrene is used for dead tissue in the body that has contact with the external environment. There are two main types of gangrene – dry and wet. In dry gangrene dead organ is black and dry, because letting moisture in the external environment. Wet gangrene occurs in dead tissue infected by putrefactive microorganisms that cause unpleasant smell and gray – green color.
Gangrene of the limbs occurs in two major diseases – atherosclerosis and diabetes. Gangrene of the legs is a final expression of acute or chronic vascular disease. Gangrene in origin may be of arterial or venous nature.
Gangrene of the legs of arterial origin
It evolves as a result of acute impaired circulation (embolism, thrombosis or traumatic injury) or end – stage of chronic arterial insufficiency (endarteritis, thromboangiitis, atherosclerosis, diabetes mellitus) in which is severely impaired limb circulation and leads to necrosis of the limb. The lack of oxygen, accumulation of carbon dioxide and acid metabolites lead to the death of nerves, soft tissues and bones.
There are two major types of gangrene of the legs from arterial origin – dry and wet. Dry gangrene is more favorable course. This is a chronic disease, which does not affect the general condition and tends to differentiate (demarcation). The wet gangrene most often develops on the background of acute arterial insufficiency or as a complication of dry gangrene. Typically for wet gangrene is rapid and dynamic development of the coverage areas of the proximal limb, no trend for demarcation. Patient’s general condition is affected by intoxication – there are fever, anemia, kidney failure. To the wet gangrene belongs gangrene in diabetes, in which are affected arterioles, capillaries and arteries of medium caliber. In diabetes, with early and severe atherosclerosis the large vessels are obliterated, and tissue metabolism is seriously impaired. Almost as a rule in these cases develops an infection that occurs rapidly and often develops phlegmon of the foot.
Treatment of arterial gangrene of the legs
Apply of vasodilators, antibiotics and medications to treat diabetes. Help against intoxication. In most cases it also represents a preparing to perform an amputation. In the dry and periphery necrosis occurring in the fingers or part of the foot is performed angiography, and parallel with vascular reconstructive surgery is taken and amputation. At higher amputation (drumstick, thigh), together with their performing palliative or reconstructive vascular interventions make a hammering functional fit to wear dentures. In “diabetic foot” are performed large incisions and drainage perfusion with antiseptic and antibiotic. In the phenomenon of intoxication are made high amputations without hermetically suturing of the hammer and wide drainage of the latter. In wet gangrene, amputations are carried out with the emergency preoperative administration of antibiotics, vasodilators and intensive resuscitation.
Gangrene of the foot of venous origin
This type of gangrene is a serious complication and the outcome from so – called blue phlebitis, in which occur total acute thrombosis of superficial and deep venous system of the limb. Embarrassed venous outflow leads to filtration of plasma out of the capillary bed in the tissues and the occurrence of massive swelling that sequester large amounts of blood in the limb. The prevalence of venous thrombosis of the veins and venous level of capillaries leads to venous gangrene.
Symptoms of gangrene of the feet from venous origin
They are dramatic, with strong pain syndrome to shock and massive swollen limb has gray- purple color. Arterial pulsations are hard to find or do not touch. Skin temperature is decreased. Gangrene begins at the periphery, covering all tissues. Bleeding bulls, ragads and ecchymosis are formed on the skin.
Treatment of venous gangrene of the feet
Starting with the transfusion of blood, plasma and fluids to overcome hypovolemic shock and arterial spasm. If possible, do phlebectomy. In formed gangrene amputation is needed urgently, and in controlled phlebothrombosis – peripheral economy amputation.
Gangrene of the extremities, especially those of arterial origin and with presence of diabetes as a background disease, develop much faster and more severe. They develop as a type of wet gangrene. Diabetes mellitus is collectively comprising a heterogeneous group of disorders in carbohydrate metabolism, leading to increased glucose fasting and postprandial. The main factor that is important in treating this type of gangrene is correct concomitant therapy of diabetes.
Primary for diabetes mellitus type 1 is the lack of insulin because of destruction of B- cells of islets of Langerhans in the pancreas. It is autoimmune disease that usually begins in young age. At the same time the number of diabetes type 2 is increasing as development of overfeeding. Overweight and obesity are decisive factors for the manifestation of diabetes mellitus type 2. Therapeutic principle in diabetes of the second type consists of removal of overfeeding and obesity.
In these patients, along with symptoms of gangrene from arterial origin are observed and symptoms of diabetes – fatigue, reduced performance, excessive hunger, sweating, headache, excessive urination, thirst, weight loss, cramps in the calves, deterioration of eyesight, skin itchy, frequent infections.