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Diabetic Gangrene Amputation

Survival And Associated Risk Factors In Patients With Diabetes And Amputations Caused By Infectious Foot Gangrene

Survival And Associated Risk Factors In Patients With Diabetes And Amputations Caused By Infectious Foot Gangrene

Survival and associated risk factors in patients with diabetes and amputations caused by infectious foot gangrene 1,2 Cheng-Wei Lin ,1 Hui-Mei Yang ,1 Shih-Yuan Hung ,1 and I-Wen Chen 1 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 2Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 1Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan 2Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, 5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan Yu-Yao Huang, Phone: +886-3-3281200, Email: [email protected] . Received 2017 Jul 25; Accepted 2017 Dec 19. Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International Li Continue reading >>

[full Text] Autoamputation Of Diabetic Toe With Dry Gangrene: A Myth Or A Fact? | Dmso

[full Text] Autoamputation Of Diabetic Toe With Dry Gangrene: A Myth Or A Fact? | Dmso

Editor who approved publication: Professor Ming-Hui Zou Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia Abstract: Diabetes is associated with various complications and reduced quality of life. Of the many complications, some are life-threatening. Among these, foot complications remain an important concern. The major foot complications include foot ulceration, cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis, with different pathophysiological concepts behind each of them. Gangrene occurs due to reduced blood supply in the body tissues that leads to necrosis. This condition may arise because of an injury, infection, or other health conditions, majorly diabetes. Gangrene is classified as dry, wet, and gas gangrene. In case of wet and gas gangrene, surgical amputation is usually performed to prevent the spread of infection to other tissues. In dry gangrene, due to the presence of clear demarcation, autoamputation is preferred in certain parts of the globe. The present review aims to analyze the mode of dry gangrene management in diabetic patients based on previous evidence and plans to highlight various management strategies available for dry gangrene and the advantages/disadvantages of different treatments with special consideration to autoamputation. Keywords: dry gangrene, amputation, surgical amputation, diabetic foot, diabetic toe, foot care Diabetes occurs due to impairment in either pancreatic production of insulin or utilization of the produced insulin. 1 It is one of the leading causes of deaths worldwide, the other causes being acquired immune deficiency syndrome, malaria, and tuberculosis. 2 With time, the worldwide prevalence of diabetes has increased more in the developing countries than in the develope Continue reading >>

Two-stage Treatment For Diabetic Foot: Surgical Peripheral Revascularization And Minor Amputation In Day-surgery Admission

Two-stage Treatment For Diabetic Foot: Surgical Peripheral Revascularization And Minor Amputation In Day-surgery Admission

1. Introduction Diabetic foot still remains a clinical and technical challenge for the vascular surgeon; local or extensive infection still threaten those presenting with critical limb ischemia (CLI). The results of successful peripheral revascularisation potentially improve limb salvage allowing to be more conservative in terms of amputation.1,2 Peripheral by-pass graft surgery or endovascular treatment such as percutaneous transluminal angioplasty (PTA) achieved progressively improved results but revascularization alone often still might not avoid minor amputations.1,2 Amputation wounds in diabetic patients are one of the most challenging to heal, especially in the foot: they are wide with exposed bone and tendons, and occurred in people with compromised healing capacity.3,4 In the last years new advanced technologies have been developed to improve the treatment of diabetic foot wounds: negative-pressure wound therapy (NPWT) has recently emerged as an adjunct for the treatment of complex wounds with reported excellent results but in limited series or anecdotal reports.5–7 We present 3 cases of diabetic patient with foot gangrene treated with a multimodal approach consisting of conventional preliminary peripheral revascularization, and subsequent minor amputation with NPWT adjunct to support wound healing performed in a day-surgery regimen. 1.1. Case report #1 She is an 80-year-old female affected by type-II diabetes and arterial hypertension; on initial admission, she complained right foot rest pain and localized wet gangrene of the first toe (grade III, category 5 according to the Rutherford classification reported in the TASC II document8). Preoperative ankle-brachial index was 0.40; computed-tomography angiography (CT-A) revealed a totally occluded superficial fe Continue reading >>

The Dangers Of Amputation

The Dangers Of Amputation

When a wound becomes gangrenous, it may have to undergo amputation. When a diabetic foot ulcer goes untreated, it can become infected, and if it When a wound becomes gangrenous, it may have to undergo amputation. When a diabetic foot ulcer goes untreated, it can become infected, and if it becomes gangrenous it may have to be amputated. This tragic scenario greatly affects a patients life, but theres also a whole host of complications that can arise. Many factors come into play, including your age and the general state of your health as well as blood flow (people with diabetes who have poor blood flow are at higher risk of amputation complications). This procedure is considered a treatment of last resort, and because of the severity of it, its important to understand these complications: Cardiac issues such as heart failure and heart attack caused by difficulty pumping the blood throughout the body Venous thrombosis, also known as blood clotting In addition to these potential physical issues comes a variety of psychological problems. For instance, many people experience phantom limb pain, which is when the patient has sensations of pain that feel like theyre coming from the missing body part. Others may experience depression and thoughts of suicide, grief and anxiety, and some even go through denial and have trouble accepting that they need to make life changes to cope with amputation. Due to the serious side effects and potential complications of amputation, its extremely important to take special care of your wounds, particularly if you suffer from diabetes. See a clinician for help if you have a wound that does not heal in a timely fashion or shows signs of infection. Then, you and a health care professional can find the right treatment plan and wound dressings for y Continue reading >>

Gangrene: Causes, Symptoms, And Treatments

Gangrene: Causes, Symptoms, And Treatments

Gangrene is a condition that occurs when body tissue dies. It is caused by a loss of blood supply due to an underlying illness, injury, and/or infection. Fingers, toes, and limbs are most often affected, but gangrene can also occur inside the body, damaging organs and muscles. There are different types of gangrene and all require immediate medical attention. Blood plays a very important role in your health. Not only does it transport oxygen and nutrients throughout your body to feed cells, it delivers disease-fighting antibodies that protect your body from infection. When blood cannot travel freely throughout the body, your cells cannot survive, infection can develop, and tissue can die from gangrene. Any condition that affects blood flow increases your risk of gangrene, including: If you think you or a loved one may have sepsis, go to the emergency room immediately. Treatment for gangrene involves removing the dead tissue, treating and preventing the spread of infection, and treating the condition that caused gangrene to develop. The sooner you receive treatment, the better your chance of recovery. Depending on the type of gangrene, treatment may include: Surgery. Also called debridement, the dead tissue is surgically removed to prevent the spread of infection. In some situations, amputation (removal of the affected limb, finger or toe) may be required. Maggot therapy. Believe it or not, maggots still play a role in modern medicine. Maggots provide a non-surgical way to remove dead tissue. When used to treat gangrene, maggots from fly larvae (specially bred in a laboratory so they are sterile) are placed on the wound, where they consume the dead and infected tissue without harming healthy tissue. They also help fight infection and speed up healing by releasing substan Continue reading >>

Autoamputation Of Diabetic Toe With Dry Gangrene: A Myth Or A Fact?

Autoamputation Of Diabetic Toe With Dry Gangrene: A Myth Or A Fact?

Autoamputation of diabetic toe with dry gangrene: a myth or a fact? Published 1 June 2018 Volume 2018:11 Pages 255264 Editor who approved publication: Professor Ming-Hui Zou Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia Abstract: Diabetes is associated with various complications and reduced quality of life. Of the many complications, some are life-threatening. Among these, foot complications remain an important concern. The major foot complications include foot ulceration, cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis, with different pathophysiological concepts behind each of them. Gangrene occurs due to reduced blood supply in the body tissues that leads to necrosis. This condition may arise because of an injury, infection, or other health conditions, majorly diabetes. Gangrene is classified as dry, wet, and gas gangrene. In case of wet and gas gangrene, surgical amputation is usually performed to prevent the spread of infection to other tissues. In dry gangrene, due to the presence of clear demarcation, autoamputation is preferred in certain parts of the globe. The present review aims to analyze the mode of dry gangrene management in diabetic patients based on previous evidence and plans to highlight various management strategies available for dry gangrene and the advantages/disadvantages of different treatments with special consideration to autoamputation. Keywords: dry gangrene, amputation, surgical amputation, diabetic foot, diabetic toe, foot care This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License . By accessing the work you hereby accept the Terms. Continue reading >>

Gangrene

Gangrene

For other uses, see Gangrene (disambiguation). Gangrene is a type of tissue death caused by not enough blood supply.[4] Symptoms may include a change in skin color to red or black, numbness, swelling, pain, skin breakdown, and coolness.[1] The feet and hands are most commonly involved.[1] Certain types may present with a fever or sepsis.[1] Risk factors include diabetes, peripheral arterial disease, smoking, major trauma, alcoholism, HIV/AIDS, frostbite, and Raynaud's syndrome.[3][4] It can be classified as dry gangrene, wet gangrene, gas gangrene, internal gangrene, and necrotizing fasciitis.[3] The diagnosis of gangrene is based on symptoms and supported by tests such as medical imaging.[6] Treatment may involve surgery to remove the dead tissue, antibiotics to treat any infection, and efforts to address the underlying cause.[5] Surgical efforts may include debridement, amputation, or the use of maggot therapy.[5] Efforts to treat the underlying cause may include bypass surgery or angioplasty.[5] In certain cases hyperbaric oxygen therapy may be useful.[5] It is unknown how commonly the condition occurs.[2] Signs and symptoms[edit] An illustration showing four different stages of gangrene, including one (Fig. 4 top right) caused by an obstacle to the return of the venous blood due to heart disease. Symptoms may include a change in skin color to red or black, numbness, pain, skin breakdown, and coolness.[1] The feet and hands are most commonly involved.[1] Causes[edit] Gangrene is caused by a critically insufficient blood supply (e.g., peripheral vascular disease) or infection.[3][7][8] It is associated with diabetes[9] and long-term tobacco smoking.[4][3] Dry[edit] Dry gangrene is a form of coagulative necrosis that develops in ischemic tissue, where the blood supply Continue reading >>

Why Is Foot Care Important If You Have Diabetes?

Why Is Foot Care Important If You Have Diabetes?

Amputation is a major complication of diabetes. If you have diabetes, your doctor has likely recommended that you check your feet each day, but you may not have known why. Read on to learn how diabetes can lead to amputation and how to help prevent it. In some cases, diabetes can lead to peripheral artery disease (PAD). PAD causes your blood vessels to narrow and reduces blood flow to your legs and feet. It may also cause nerve damage, known as peripheral neuropathy. This could prevent you from feeling pain. If you can’t feel pain, you may not realize you have a wound or ulcer on your feet. You may continue putting pressure on the affected area, which can cause it to grow and become infected. Reduced blood flow can slow wound healing. It can also make your body less effective at fighting infection. As a result, your wound may not heal. Tissue damage or death (gangrene) may occur, and any existing infection may spread to your bone. If the infection cannot be stopped or the damage is irreparable, amputation may be necessary. The most common amputations in people with diabetes are the toes, feet, and lower legs. In 2010, 73,000 American adults who have diabetes and are over age 20 had amputations. That may sound like a lot, but amputations account for only a small percentage of the over 29 million people in the United States with diabetes. Better diabetes management and foot care has caused lower limb amputations to be reduced by half over the last 20 years. With ongoing diabetes management, foot care, and wound care, many people with diabetes can limit their risk of amputation or prevent it entirely. The best way to prevent amputation and other severe diabetes complications is to manage your blood sugar. There are several ways you can do this, including: eating a health Continue reading >>

Age, Gangrene Among Predictive Factors For Amputation In Diabetic Foot Patients

Age, Gangrene Among Predictive Factors For Amputation In Diabetic Foot Patients

Age, gangrene among predictive factors for amputation in diabetic foot patients Yet, only peripheral vascular disease and infection were significant with stepwise regression analysis. Please provide your email address to receive an email when new articles are posted on this topic. Receive an email when new articles are posted on this topic. Major amputation remains a significant complication of patients with diabetic foot problems. Now, research indicates the predictive factors for below-and above-the-knee amputation in these patients. In a prospective study, Aziz A. Nather, FRCS, MD, and colleagues prospectively studied 202 patients with diabetic foot problems treated at the National University Hospital in Singapore between January 2005 and May 2006. A univariate analysis of the cohort showed the following significant predictive factors for limb loss from major amputation: comorbidities such as ischemic heart disease and stroke; Ankle Brachial Index score of less than 0.8; glycosylated hemoglobin level (HbA1C) of more than 7%; diabetic complications such as nephropathy, sensory neuropathy and peripheral vascular disease; pathogens such as pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA). However, a stepwise logistic regression analysis revealed that only peripheral vascular disease and infection were significant. Clinicians need to be aware of the significant risk factors as presented in this research, Nather told . These factors pose a high risk that could lead to limb loss. He presented the research at the 15th Triennial Congress of the Asia Pacific Orthopaedic Association. To determine the predictive factors for amputation, investigators noted the patients diabetes type and duration, presence of diabetic complications and comorbidities, Continue reading >>

Toe Amputation: Background, Indications, Contraindications

Toe Amputation: Background, Indications, Contraindications

Toe amputation is a common procedure performed by a wide variety of health care providers. The vast majority of toe amputations are performed on patients with a diabetic foot . [ 1 ] Although regional variation is noted, most of these procedures are done by general, vascular, and orthopedic surgeons (particularly those subspecializing in foot and ankle surgery); in some countries, podiatrists are involved. There are three broad indications for amputation of any body part, as follows (see Indications) [ 2 ] : Before any amputation, the clinician should ensure that the patients medical circumstances have been optimized (ie, should "reverse the reversible"). With impending toe amputation, this step encompasses such measures as glycemic control and consideration of revascularization when severe macrovascular disease is contributing to ischemia. The method of toe amputation (disarticulation vs osteotomy) and the level of amputation (partial or whole phalanx vs whole digit vs ray) depend on numerous circumstances but are mainly determined by the extent of disease and the anatomy. With any amputation, the degree of postoperative functional loss is generally proportional to the amount of tissue taken. The great toe is considered the most important of the toes in functional terms. Nevertheless, great-toe amputation can be performed with little resulting functional deficit. [ 3 , 4 ] A dead toe is one in which the blood supply is so completely impeded that infarction and necrosis develop (see the images below). Infarction results in dry gangrene, with nonviable tissue becoming dry and black in color (because of the presence of iron sulfide, a product of the hemoglobin released by lysed erythrocytes). Gangrenous fifth toe. Dubious perfusion in fourth toe. In Western societies, a Continue reading >>

Diabetes And Amputation: Everything You Need To Know To Avoid Amputation

Diabetes And Amputation: Everything You Need To Know To Avoid Amputation

In this article, we will cover everything that you need to know about how to avoid an extremity amputation due to diabetes. We will cover skin and foot care, what to look for, and when to contact your doctor. We will discuss whether or not you need to see a podiatrist, and what to do if you do have a diabetic foot ulcer. We will look at how to get it treated, so that it heals and doesn’t progress to amputation. We will also look at what to do if you are going to have, or have already had an amputation due to your diabetes. We will look at ways you can become mobile again safely. We will also discuss ways to protect your remaining limbs so that you don’t have another amputation later. We will discuss what to look for related to residual limb care, and how to locate needed resources, such as a physical therapist. In my own experience as a nurse for 22 years, and as a certified diabetes educator, I have seen many people with diabetes lose functional mobility, and even their life, after an amputation. I have seen a person go from having a blister and not even knowing they have diabetes to having a below the knee amputation in under two weeks. In addition, I have worked with people who have been through femoral popliteal bypass surgery, amputation of the toes, then a below the knee amputation. I have watched them come in and out of the hospital until they have an above the knee amputation. With cardiovascular disease, the risk of another amputation is very high. I have watched their pain and suffering, and seen the struggles that their families go through after amputation due to complications of diabetes. I have sat up late with them, while they try to deal with phantom residual limb pain, as their mind plays tricks on them and they feel pain in the already amputated leg Continue reading >>

Treatment Of The Diabetic Foot – To Amputate Or Not?

Treatment Of The Diabetic Foot – To Amputate Or Not?

Go to: Foot ulcers affect one in ten diabetics during their lifetime [1]. Patients with diabetes have increased risk of lower-extremity amputations and the main cause is diabetic peripheral arterial disease accelerated by the direct damage to the nerves and blood vessels by high blood glucose levels. Wound healing is also impaired from affected collagen synthesis [2, 3]. Diabetic vascular disease has three main components: arteritis and small vessel thrombosis; neuropathy (possibly ischaemic in cause); and large vessel atherosclerosis. In combination these are almost bound to cause problems in the weight- bearing areas. The diabetic foot ulcers are often deeper and more frequently infected than other leg ulcers reflecting the severe end vessel ischaemia and opportunistic infection which is the common experience of the diabetic [1–4]. Factors, such as age and the duration of the disease will increase its incidence and risk of death from uncontrolled infection [4, 5]. Once tissue damage has occurred in the form of ulceration or gangrene, the aim is preservation of viable tissue, but the two main threats are infection and ischaemia [3]. Ulcers should not be automatically treated with antibiotics since although as open chronic wounds there may be many commensal organisms, about half are not infected [3–5]. Several foot-ulcer classification methods have been proposed in order to organize the proposed appropriate treatment plan but none have been universally accepted. The Wagner- Meggitt classification is based mainly on wound depth and consists of 6 wound grades (Table 1) [6]. The University of Texas system grades the ulcers by depth, then stages them by the presence or absence of infection and ischaemia [6, 7]. As there is the need for rapid and more appropriate therapy Continue reading >>

Amputation And Diabetes

Amputation And Diabetes

If you have diabetes, you're at higher risk for many related health problems, including foot or leg amputation. That's when you have surgery to remove a limb or a digit like a toe or finger. But you can do some things to keep your feet and legs healthy. And if your doctor recommends amputation, you can still protect your health and prevent future problems. Diabetes is linked to a condition called peripheral artery disease (PAD). It can narrow the arteries that carry blood to your legs and feet and make you more likely to get ulcers (open sores) and infections. It also can make those things heal more slowly. High blood sugar levels caused by diabetes can damage the nerves and blood vessels in your body. That includes the ones in your feet and legs. If your nerves are damaged, you might not feel pain or other symptoms of ulcers or infections. That raises your risk of serious infection or gangrene, which refers to the death of your tissue. In some severe cases, the only way doctors can treat the infection or gangrene is to amputate, or remove, the area that's affected. If you have diabetes, it's especially important to take good care of your feet to lower your risk of amputation. you might like Check your feet every day. Look for changes like: Cuts Cracks Sores Redness White spots or areas Different colors If they're colder or warmer than usual, that can also be a sign something's wrong. Run a feather or light object along your foot to make sure you can feel it. If you can't check your own feet, ask a family member to help you. If you notice a problem or aren't sure if something's normal, call your doctor. Don't smoke: Smoking damages your small blood vessels and affects blood flow to your feet. It also makes it harder for your body to heal. Those things raise your risk of Continue reading >>

Diabetes And Gangrene

Diabetes And Gangrene

Diabetes mellitus is a condition where the body is unable to control the blood sugar. Normally the body has a good immune system that fights against microbes and invading organisms that may lead to infections. The white blood cells are the main fighters in this respect to keep the body protected. (1-5) In patients with diabetes, the immune system of a person is affected. In addition, the blood vessels are damaged due to the excessive blood sugar running in the veins. Peripheral neuropathy and gangrene Also diabetes leads to damage to the nerves in the long run. This is called peripheral neuropathy. This leads to lack or decreased pain sensation. So if a diabetic patient gets accidentally poked, hurt, cut or burnt especially in the limbs or extremities like toes and fingers he or she may not be aware because the cut may not hurt. Pain usually alerts a normal person to care for a hurt area in order to prevent infections. In diabetics this is absent and the wound often gets infected. Diabetes and the immune system Further diabetes weakens the immune system which is unable to fight the invading organisms at the wound. High blood sugar makes the blood more favourable for bacterial and microorganisms to grow. Foot infections in diabetics In diabetics the common sensitive areas affected are lungs, skin, feet, urinary tract, genital area and mouth. In diabetics skin infections are detected commonly because of their visibility and not because of their pain. Diabetics commonly get foot infections. This is because the feet are commonly exposed to injury and bumps and bruises in the activities of daily living. Foot infections may begin as small ulcers and may invade deeper tissues, lead to gangrene or affect the bones and invade the blood stream as well. It is found that nearly hal Continue reading >>

Diabetes And Amputation

Diabetes And Amputation

Tweet Diabetes, when present in the body over many years, can give rise to all sorts of complications. These include heart disease, kidney disease, retinopathy and neuropathy. If left untreated, some of these complications can become extremely damaging to the body. Diabetes is a leading cause of amputation The NHS reports that people who have diabetes are 15 times more likely to undergo amputations than other people without the condition. Diabetes is one of the leading causes of amputation of the lower limbs throughout the world. Charity Diabetes UK notes that problems of the foot are the most frequent reasons for hospitalisation amongst patients who have diabetes. Many hospital visits due to diabetes-related foot problems are preventable through simple foot care routines. All people who have diabetes should have foot check-ups as a part of their regular care routine. What factors lead to amputation? Several key factors usually predispose ulceration and ultimately amputation. These include: Circulation problems Other damage to the foot How are these factors assessed? Diabetic foot complications are more common amongst the elderly, and amputation rates do increase with age. For people over 75 years old, the risk does increase considerably. All people who have diabetes should have a basic education in foot care, and beyond this they should have regular foot examinations. The risk for the development of ulceration can be assessed by basic clinical examination of the foot. What are major and minor amputations? Amputations in general, not just diabetes-related amputations, are classed as major and minor. Minor amputation regards removal of toes or feet. Major amputation refers to the above or below the knee amputation. How should I identify a foot at risk from amputation? Lo Continue reading >>

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