Gangrene is a serious complication of diabetes, which often leads to limb amputation. The risk of its occurrence may be increased by additional factors - improper lifestyle, failure to follow diet, rest, vascular diseases, and others. That provokes the development of gangrene, its symptoms and stages of progression, as well as diagnosis and treatment, read further in our article.
Read in this article.
What is gangrene
Due to the critical reduction in blood flow, tissue death occurs - gangrene. The characteristic dark blue or brownish, black color is caused by the destruction of hemoglobin and the formation of iron salts. When wet gangrene substances from the source of decay pass into the vascular bed, leading to severe poisoning.
This condition is a complication of diabetic foot syndrome. Patients with type 2 disease are at high risk, even with the recent detection of high blood sugar. With insulin injected (with type 1 diabetes), the likelihood of gangrene increases from the age of 8-10. With a late visit to the doctor often requires amputation of the foot or more significant part of the leg.
And here more about wounds in diabetes.
Causes of damage to the lower limbs with diabetes
The main factor of development is a long-term elevated blood glucose level. Its molecules injure the vascular wall, nerve fibers (angiopathy, neuropathy), and the blood acquires excessive viscosity.
As a result, the patency of the arteries and the sensitivity of the lower limbs are reduced. Minor injuries on this background are the cause of nonhealing ulcers. When an infection penetrates, the bacterial enzymes loosen deeper tissues, helping to spread pus. They cry out and cell death - necrosis.
The second reason for the development of tissue death is changes in the supporting surface. Joints and bones are damaged due to the binding of proteins to glucose, insufficient innervation. Since the ankle carries the highest load when walking, deformations arise with the redistribution of pressure - subluxation, compression of the tissues, restriction of mobility.
The risk of developing diabetic foot and gangrene is increased in the presence of additional risk factors:
- extensive atherosclerosis, excess fat intake, lipid metabolism disorders - cholesterol plaques block the blood flow through the arteries of medium and large caliber,
- arterial hypertension - high pressure causes a hardening, stiffness of the artery walls,
- alcoholism - there is a rapid destruction of nerve fibers,
- smoking - provoke a steady vascular spasm,
- reduced immunity - facilitates the penetration and spread of infection
- venous insufficiency, varicose veins of the lower extremities - blood flow is disturbed, excretion of metabolic products, edematous tissues squeeze arteries,
- obesity - creates an additional load on the joints, contributes to the progression of atherosclerosis, diabetes and hypertension,
- heart failure - slowed blood movement due to low pumping function of the heart, there are congestion, swelling.
Accelerated development of extensive gangrene cause:
- lack of treatment
- disregard of the rules of nutrition,
- antisocial lifestyle,
Symptoms of a toe or toe
The skin becomes initially pale, cold to the touch. Then their color changes to marble, bluish and dark brown. With the complete destruction of the tissue, the fingers turn black. Sensitivity to touch and temperature changes is reduced. Patients may feel tingling, itching, burning, or unbearable pain. The pulse on the arteries of the feet is not detected.
When dry gangrene destruction is limited to the area of lack of blood flow. Tissues shrink, limb volume decreases. With a wet skin type, edematous, the process of rotting. Decayed tissues have a characteristic fetid odor; toxins from them penetrate into the bloodstream, causing a general reaction of the body.
Symptoms of gas gangrene
Stages of progression gangrene
Depending on the severity of circulatory disorders and tissue destruction, the stages of the disease are highlighted.
It includes a deep foot ulcer with focal tissue necrosis. The lesion covers the skin, subcutaneous layer, muscle fibers, tendons, bones. There is swelling, a violation of sensitivity, constant pain. At this stage it is possible to carry out treatment without amputation. Destroyed tissue excised, conduct local therapy.
Places of diabetic gangrene
Dry and wet gangrene with diabetes
If the lumen of the vessels that feed the foot, partially pass, then the appearance of a dry process of destruction. Fabrics are dehydrated and dry, compacted. With wet gangrene, the blood flow is completely blocked, there is decomposition, rotting, accumulation of pus and gases.
Initially, severe pain is felt below the occluded vessel. The foot is cold, the patient does not feel the touch, the foot becomes numb and turns pale. Above the site of the obstacle tissue edematous, filled with blood. This zone between healthy and dead cells becomes borderline - demarcation. Due to the fact that it has an inflammatory process, patients have a prolonged pain syndrome.
Blackening of the skin is understood up the leg, but then stops. The dead part is compacted and dries (mummified), perhaps even spontaneous rejection. Scar tissue is formed in the demarcation area, so toxins do not penetrate into the bloodstream. The general condition of patients is relatively satisfactory.
Against the background of pale and cold skin, bubbles and spots are formed. The leg is swollen, the veins are dilated. It is impossible to determine the extent of damage, the destruction continues, the process moves towards the lower leg. The fabrics are friable, when probing they crunch due to the accumulation of gases. Rotting is accompanied by a characteristic odor.
Since there is no limiting demarcation zone, all the waste products of bacteria and toxins of decayed tissues rush into the blood. The body temperature rises, a headache, emetic desires appear, the consciousness becomes clouded.
Signs of diabetic gangrene include:
- decrease in sensitivity or its complete loss,
- deformity of the ankle, feet, limited mobility,
- swelling or reduction of limb volume depending on the type of gangrene,
- in the presence of an ulcer - signs of infection, discharge of pus,
- weakening of tendon reflexes,
- blood glucose increased (from 7.5 mmol / l before meals), glycated hemoglobin (6.5%), low density lipoproteins, cholesterol and triglycerides,
- in the urine is determined by glucose, ketone bodies,
- Seeding detachable ulcers - detect bacterial flora, determine the sensitivity to drugs,
- Doppler ultrasound - reduced blood flow, impaired patency, cholesterol plaques, dense arterial walls with low mobility, calcium deposition, thrombosis,
- angiography - extensive damage to the bloodstream,
- foot X-ray - destruction of articular surfaces, bone tissue, decrease in mineral density, osteomyelitis (inflammation of bone, bone marrow).
Look at the video about ultrasound veins of the lower extremities:
All diabetics are transferred to frequent injections of short insulin. Dose is selected to fully compensate for high blood sugar. Assign an introduction:
- correctors of blood circulation - Alprostan, Trental, Kurantil, Reopoliglyukin,
- anticoagulants - Heparin, Fraxiparin (thin the blood),
- antibacterial agents - Rocephin, Tsiprinol, Cefodar, Metrogil. An antibiotic change is needed after detecting the sensitivity of bacteria,
- immunity stimulants - T-activin, Timalin,
- vitamins - Milgamma, Neyrobion,
- antioxidants - vitamin E, Berlition (improve metabolic processes, nerve fiber function),
- antihypertensives - Enap, Ebrantil (prevent the increase in pressure).
A number of drugs can be administered intraarterially. For this, the femoral artery is punctured, Heparin, insulin, antibiotics, Trental, Nicotinic acid, Reopolyglucine enter the bloodstream through it. This allows you to create a local, higher concentration of drugs.
Exchange blood transfusion is applied, plasma is replaced by Albumin, donor plasma, plasmapheresis and hemosorption are prescribed. To reduce the load on the foot, the use of crutches, strollers is shown.
Amputation of leg, toe
If the gangrene is dry, then medication is predominantly prescribed. After the complete formation of the demarcation shaft, the dead tissue is removed. Then apply dressings and local means to heal and clean the wound.
Wet gangrene preparations tend to translate into dry. Then determine the amount of the operation. The patient may be assigned a necrotomy. Non-viable tissue is cut to determine the boundaries of necrosis, the appearance of a path for the outflow of pus and toxins. With a small amount of destruction remove only the dead area of the skin and subcutaneous layer. In the future, plastic is assigned to close the defect.
Amputation is necessary with extensive necrosis and the threat of spreading the process up the limb. At best, you can manage to remove a finger, part or the entire foot. In case of late treatment of a patient or rapid tissue destruction, a high limb excision is necessary.
Since amputation does not guarantee the restoration of blood circulation in the remaining part of the leg, and the wounds heal for a long time, planned reconstructive operations are recommended in the long-term period. Diabetics prescribed:
- stenting - expansion of the artery with a balloon at the end of the catheter, the installation of the stent,
- sympathectomy - removal of the nodes of the nervous system for sustainable relaxation of blood vessels,
- shunting - making a workaround with the patient’s own vein.
General forecast, how many patients with gangrene live
Despite the possibilities of modern treatment, about 1% of diabetics lose their feet. Hundreds of thousands of amputation operations in the world are performed annually, half of them at the hip level. The prognosis and longevity are determined by the stage of the disease at which it was detected, the degree of infection and the presence of blood infection.
With dry gangrene, there is every chance of survival, but depending on the level of amputation in diabetics, the ability to move is impaired, and the help of outsiders is needed.
Preventing the development of complications of diabetes
It is possible to prevent gangrene and the appearance of its predecessor, diabetic foot syndrome, only if the diabetes is compensated. Compliance with the following recommendations helps to avoid neuropathy and vascular complications:
- completely exclude products with simple carbohydrates (sugar and flour), dramatically reduce the intake of animal fats,
- Strictly adhere to the necessary dosages and rules for the use of glucose-lowering drugs,
Blood sugar control
- monitor blood sugar daily with a glucometer, donate blood from a vein in the laboratory at least once a month, determine glycated hemoglobin, cholesterol every three months, examine blood clotting using a coagulogram,
- at the first symptoms of circulatory disorders (constantly cold feet, reduced sensitivity, pale skin) contact a vascular surgeon for further examination and prophylactic treatment,
- give up smoking and alcohol
- walk daily, perform a complex of therapeutic gymnastics,
- every night to inspect the foot,
- protect your feet from freezing and injury
- pick up orthopedic shoes.
And here more about the diabetic neuropathy of the lower extremities.
Gangrene in diabetes is the outcome of the progression of diabetic foot syndrome. When the dry form of the fabric shrinks, a separating shaft is formed. When wet gangrene without treatment, rotting and rapid spread of the lesion occurs. For the diagnosis of vascular disorders, it is necessary to conduct an ultrasound, angiography.
Therapy is carried out in a hospital. Prescribe drugs to restore blood flow, increase blood flow, antibiotics. In the dry form, the dead tissue is cut off; in the case of a wet form, amputation is performed depending on the extent of the lesion.
The first symptoms of diabetic foot may be immediately invisible due to the decreased sensitivity of the extremities. At the initial stage, at the first signs of the syndrome, it is necessary to begin prophylaxis, in the advanced stages of treatment, the amputation of the leg can become.
If a diabetic foot develops, treatment should begin as soon as possible. At the initial stage, ointments, traditional medicine and a laser are used to improve blood circulation and vascular condition. Surgical treatment and some modern preparations are suitable for ulcers.
Due to fluctuations in sugar levels, effects on the insulin wall, diabetes wounds appear that do not heal well. These are the main reasons why skin is broken and poorly healed. Wounds can be purulent, non-healing, moist. There are special means for treatment and treatment, sometimes the help of a surgeon is required.
Diabetic neuropathy of the lower extremities arises due to prolonged blood sugar jumps. The main symptoms are tingling, numbness in the legs, pain. Treatment includes several types of drugs. You can anesthetize, and gymnastics and other methods are recommended.
If at the same time the patient has cholecystitis and diabetes, then he will have to reconsider the diet if the first disease has only developed. The reasons for its occurrence lie in the increased insulin, alcoholism and others. If acute calculous cholecystitis develops on the background of diabetes mellitus, surgery may be required.
How does diabetic gangrene of the limbs arise?
Diabetic gangrene syndrome results from a combination of factors:
Angiopathy - changes in blood vessels due to long-acting hyperglycemia (elevated blood sugar levels), is reflected in a decrease in the elasticity of the vessels and the violation of their patency, as well as in increased blood viscosity,
Neuropathy - changes in peripheral nerves, leading to impaired innervation, loss of tissue sensitivity,
Infection - introduction of pathogenic microflora (clostridia, staphylococcus, streptococcus, colibacteria) into wounds and ulcers on the skin of the limbs.
Due to the violation of protein metabolism, the mobility of the joints is reduced, the bones of the lower limbs are deformed. These changes lead to increased load on the foot. Due to the fact that the natural protection of the body in the form of local immunity is reduced or completely absent, any microtrauma (bruise, abrasion, abrasion, crack, cut) leads to the appearance of non-healing ulcers. The accession of the infection contributes to tissue necrosis, the spread of the process to the muscles, bones, ligaments, subcutaneous fatty tissue.
Factors that increase the risk of gangrene in diabetics:
Hypertension, ischemic disease, history of atherosclerosis,
Alcohol abuse, smoking,
Damage to the tissues of the legs - ingrown nail, foot and nail fungus, corns, heel cracks,
Failure to follow basic hygiene for foot care,
Obliterating endarteritis, causing blood clots,
The bedsores occurring in bedridden patients.
Decrease in general immunity, excess weight increase the chances of a diabetic patient to develop gangrene in him.
Forms of gangrene of the extremities and their symptoms
At the initial stage of the pathological process is very difficult to determine the development of gangrene. There are ischemic, neuropathic and mixed forms of the disease, each of which has its own symptoms. At the beginning of the disease there are no ulcers, but there are deformities of the epidermis in the form of corns, keratosis and other injuries.
Stages of gangrene:
Superficial ulcers appear on the skin.
Deep ulcers capture not only the skin, but also the muscles, tendons, and subcutaneous tissue, not reaching the bones.
Deep ulcers seize the bones.
Gangrene occupies a limited area.
Gangrene occupies a vast area.
At the heart of ischemic gangrene is damage to the blood vessels that cause poor circulation. The neuropathic form is caused by damage to the nervous system.
Symptoms of the ischemic form of the disease:
Leg pain when walking (at the onset of the disease, the patient can pass up to 1 km of pain, at the second stage - up to 200 m, at 3 stages - less than 200 m or at rest, at 4 stages there is finger necrosis),
Persistent leg swelling,
Lack of pulsation on the arteries,
The skin of the affected leg is pale and cold, there are areas of hyperpigmentation,
On the site of damage, ulcers appear with a black bottom.
Since the ischemic form manifests dry necrosis, no exudate is secreted. In the future, the affected areas dry out, "mummified", may even spontaneously fall away.
If an infection joins, the inflammatory process develops rapidly, leading to edema, severe pain. There are almost no boundaries between the gangrenous and healthy parts. This complication quickly leads to sepsis and, in many cases, death.
Symptoms of neuropathic gangrene in diabetes mellitus:
Burning in the feet, feeling of running through goose bumps, weak pain at night in the legs, characteristic of the initial stage of the disease,
The skin is warm and dry, dark spots appear on it,
Thermal, tactile, pain sensitivity is reduced,
The edges of the ulcers appear swollen and hyperemic,
Under the skin accumulates interstitial fluid,
The pulsation on the arteries is preserved,
The toes of the foot become hooked, the heads of their bones protrude,
Leg joints swell and deform.
In the later stages of the development of the disease, severe pain appears, the smell of decay appears, the temperature rises, blood pressure drops. The pain is not stopped even by the strongest analgesics, there are convulsions, trembling of the extremities, delirium.
Gangrene treatment methods
The main directions of treatment of gangrenous process of the lower extremities:
Reducing blood sugar by adjusting insulin dosage,
Antiseptic treatment of wounds with the use of antibacterial drugs,
Medical system therapy,
Unloading the affected leg - using crutches, gurney, special shoes and insoles,
Blood pressure reduction with diuretics, calcium antagonists, ACE inhibitors, beta-blockers.
Preparations for systemic therapy:
Improving blood circulation - Trental, Actovegin, Reopligluken, Vazaprostan,
Dissolution of blood clots - Heparin,
Relieving spasms - Drotaverine, Papaverine,
Enhance immunity - multivitamin complexes.
The rapid spread of infection, the lack of effect of conservative treatment is a reason for surgical intervention.
For this, not only amputation is applied, in the arsenal of modern vascular and general surgery there are other methods:
Peripheral artery stenting,
Arterialization of the veins of the foot,
Autodermoplastika to close a large area of the wound,
Drainage of arising abscesses,
At the same time, antibacterial therapy, treatment with hormone-based anti-inflammatory drugs, and diuretic drugs are carried out. A radical measure — removing toes, feet, or legs — is used last. This need arises in 12-25% of cases in the later stages of the disease.
How to prevent the development of gangrene in diabetes?
In order to prevent the appearance of wounds or ulcers on the legs, it is important to carefully care for the feet, avoid injury to them, wear quality shoes, orthopedic insoles. The patient must control the level of glucose, follow a diet, use medications regularly.
Socks and tights should contain a minimum amount of synthetic materials. In hot weather, shoes are regularly washed, dried and changed. Feet are often washed in cool water and examined for microtraumas and cracks between the fingers.
In case of diabetes mellitus, it is important to carefully consider your health, to observe preventive measures.
Education: Moscow State University of Medicine and Dentistry (1996). In 2003, he received a diploma from an educational and scientific medical center for managing the affairs of the President of the Russian Federation.
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Gangrene is a rather complicated disease characterized by tissue death. The causes of gangrene are different. The death of tissues can be a consequence of their poor blood supply, due to poor circulation of blood through the vessels or due to complete cessation of blood circulation, as well as from the influence of external factors, such as chemical.
This form of gangrene is an anaerobic infection because it is caused by microbes that function and reproduce without air. Pathogenic spore-forming bacteria from the genus Clostridia enter the human body in violation of the integrity of the skin. In a very short time, they spread to more deeply located ones.
Necrosis of tissues due to cessation of blood circulation, which is not accompanied by exposure to infectious factors, is called dry gangrene. Its characteristic feature is the loss of moisture in the affected segment, loss of sensitivity and the possibility of self-healing as a result of rejection of the necrotic area.
A variety of necrotic tissue breakdown that has arisen as a result of circulatory disorders due to injury, thrombus, adipose tissue, a fragment of bone in a fracture vessel, as well as blood flow disorders in diabetic patients, is called wet gangrene. In this form, the gangrene of the body tissue undergoes putrefactive decomposition.
Gangrene is a very complex surgical pathology with an unpredictable outcome. Its treatment requires a lot of time and effort, although with reduced immunity, even the most modern drugs do not guarantee a positive result. Traditional recipes can remove the negative symptoms of the disease, bring recovery, although it should not.
Primary symptoms of the disease
The primary signs of gangrene in diabetes mellitus begin to manifest when the occurrence of obliterating atherosclerosis. The disease is characterized by a narrowing of the vascular system and the occurrence of lipid plaques, which is the primary cause of impaired blood circulation in the body. This entails an insufficient supply of oxygen compounds to cellular and tissue structures. In the absence of proper treatment of concomitant diseases, gangrene of the lower extremities begins with the development of diabetes. An important point for every diabetic is knowing what gangrene looks like at the beginning of its development.
The main symptoms of the beginning leg gangrene in diabetes include:
- The presence of intermittent claudication, the foot is deformed. At the same time, the patient begins to feel the soreness of the muscle tissue in the gastrocnemius, fatigue, stiffness, even with a slight walk.
- Cold limbs at any time of the year.
- The appearance of convulsive phenomena on the leg.
- Feeling tingling or dumb limbs, loss of the toes of the feet with the fingers to feel something.
- The skin becomes waxy, some areas of the skin turn pale or become blue, purple color.
- The appearance of ulcerations, the dying off of individual areas of the skin, smoothly turning into wounds that are affected by infections.
- The appearance of purulent abscesses, entailing fever, vomiting reflexes, and more.
Onset of the disease
Finding the primary symptoms of gangrene on the leg, you must immediately get an appointment with the doctor. The sooner adequate therapy begins, the more favorable the prognosis of treatment will be. If a disease is detected at this stage, the treatment will be justified; otherwise, without amputation of a finger, foot or foot, the person will not survive. How does gangrene start?
Photo gangrenous phenomena of the foot in diabetes
The initial stage of the occurrence of such problems with the legs as gangrene in diabetes is the development of a diabetic foot in a patient. The disease often develops in older people who have a high probability of malnutrition of tissue structures due to microangiopathy and neuropathy.
The initial stage of gangrene of the foot with diabetes is shown in the photo:
At the same time, even minor injuries, scratches, callus formation, together with impaired blood circulation, thrombosis, congestion in the leg area and infection of infections, entail incipient necrosis and gangrenous phenomena.
There is a dry and wet gangrene variety. The dry form of gangrene in diabetics develops at a rather slow pace.
Dry gangrene of the lower extremities at the initial stage is shown in the photo:
This gangrene of the foot begins with itching, feeling of coldness in the legs, the feet feel burning sensations. Then there is a loss of sensitivity, there are periodic convulsive seizures. The skin becomes overdried, peeling, blackening. The leg takes on a mummified look. In the affected areas increases skin necrosis. Offensive odor is not observed, well-being is not disturbed.
Gangrene of a wet type with diabetes gets instant development. Photos of the initial stage of wet gangrene of the legs can be seen below:
The foot at the same time begins to increase in size, becomes green or purple hue. Begin to feel the sharp fetid odor of rot. The disease is rapidly covering healthy areas of the skin, fiber, muscle and bone. The beginning of the process of necrosis provokes the covering of skin areas with small bubbles. Pressing on the damaged area provokes crispy sounds.
The diabetic's condition begins to deteriorate, his blood counts become worse, leukocytosis symptoms manifest, an increase in the ESR is observed.
To save the patient's life, an immediate amputation of the affected limb is necessary.
Gangrene on the fingers
Gangrene of the toes in diabetes arises due to the lack of sensitivity in this area and circulatory disorders in the extremities. Due to the fact that the diabetic ceases to feel pain in the legs, it is likely to receive injuries of the fingers, since any blow they can go unnoticed. Damage to the skin in the area of the finger begins to fester and quickly lead to necrosis of the skin, destruction of tissue structures, suppuration.
In order to stop the infection of healthy tissues, the finger is amputated. Another point in the development of gangrene of the fingers is the loss of the vascular system of the fingers in its patency. Often such gangrene develops for a long time. As a result of such violations, the tissue structures of the fingers begin to dry, leaving no wounds, so infection is not formed. There is a mummification effect. In this form, the toes can be preserved by the surgical treatment of the vascular system.
The development of gangrene in the elderly
Often, in older people, whose body is dehydrated due to age-related changes, dry gangrene is observed under the influence of diabetes and other diseases, but it can also be wet. Dry is characterized by very strong and sometimes unbearable pain, swelling of the limbs. Next comes the loss of sensitivity. After that, there are two options for the development of circumstances: injury to the legs with the addition of purulent infection or drying of the legs and the acquisition of coal-black. Treatment of gangrene in the elderly is complicated by slower regeneration processes.
To treat gangrene is necessary to eliminate the root causes of its occurrence. To this end, the treatment and treatment of any injuries, scratches, callous growths, ingrown nail plates, preventive measures and antibacterial therapy of infectious lesions, surgical removal of dead skin, removal of toxins from the body.
Gangrene therapy can be carried out using two main methods: conservative and surgical treatment. The first method is characterized by insignificant efficiency, while the last one is the most effective.
Conservative treatment of gangrene in diabetes includes the provision of therapeutic interventions to compensate for diabetes, prevent infection and intoxication with antibiotics, reduce pressure on the limbs, improve the immune response through the use of vitamin complex and trace elements. Such methods are justified at an early stage of the disease and in dry gangrene.
In some cases, carry out parallel treatment of related diseases. It includes:
- Removal of blood clots from the vascular system obtained during the course of ischemic disease. To do this, use probing.
- Minimally invasive surgical intervention by the method of shunting.
- Stent installation.
- Treatment of critical ischemia, which reduces pain.
However, if there is a wet gangrene, then in order to prevent the death of the patient, in any case, surgical treatment is necessary. During the operation, the affected areas of tissue structures are removed, and the surrounding healthy lesions are cleaned.
In this case, the leg is subject to amputation above the lesion, which makes it possible to prevent further infection. If the lesion covered only a finger, then in order to prevent undesirable consequences, the whole foot can be removed. In the case of a gangrene of the foot, you can talk to a person about the amputation of the foot by the knee.
In parallel with the operative therapy, treatment with antibiotics, elimination of toxins from the body, blood transfusion is allowed.
Together with the removal of dead cell structures, parallel therapy is often carried out to eliminate blood clots from the vascular system of the legs by inserting a probe. A shunt can also be inserted to keep the foot if a finger is damaged, or a stent that has a positive effect on the operation process.
How many live with the disease
How long do diabetics suffer from gangrene? The dry type of gangrenous phenomenon is not able to have at least some effect on the life expectancy of the patient and in very rare cases becomes the root cause of the death of the diabetic. The patient can only die from the disease, which was the main cause of gangrene. But with a wet type of gangrene, a patient without the necessary therapy can last only three days, sometimes even less. Therefore, every minute is important at the beginning of treatment.
The implementation of preventive measures, timely adequate therapy is the key to the preservation of health and, as far as possible, the long life of a diabetic.
Diabetic Foot Syndrome Forms
There are 3 forms of diabetic foot syndrome:
- Neuropathic form. Nerve damage prevails. As a result, the sensitivity decreases, the skin becomes dry, the muscles atrophy. The foot is damaged more quickly, trophic ulcers appear, and because of the reduced pain sensitivity the patient does not notice this.
- Ischemic form. Prevailing lesion of blood vessels. There are pains in the calf muscles when walking. The skin of the legs becomes pale, cold, hair falls out. Perhaps the development of gangrene.
- Mixed form.
Signs and symptoms of gangrene
Gangrene in diabetes usually begins with a stop. As a result of the progression of diabetic foot syndrome, there is a sharp impairment of blood circulation in them. Against the background of insufficient oxygen supply, the foot tissue dies off. Also, the beginning can serve as a long-term untreated trophic ulcer, which becomes infected, increases in size and leads to gangrene.
There are two types of gangrene, differing in the mechanism of development and symptoms.
With a slowly developing blood flow disturbance, the foot tissue dies, loses moisture, dries out, shrinks. The blood from the vessels gets into the surrounding tissues, is destroyed to iron, causing the dark color of the dead areas. Inflammation appears on the border with healthy tissues. Dry gangrene begins with severe pain below the artery blockage site. The finger becomes pale, cold, in the future - bluish, then blackens or turns purple. If no medical assistance is provided, the process spreads higher to the level of sufficient blood flow. Sometimes on the border with healthy tissues, spontaneous amputation can occur - rejection of damaged tissues. Dry gangrene is more common in thin people.
Occurs when a sharp violation of the blood flow, more often on the background of edema, lymphostasis, in people with obesity.
Characterized by infection, leading to severe intoxication of the body.
Starts with blanching of the skin. Then red spots and bubbles filled with transparent contents appear on it. Leg quickly swells, hurts, then loses sensitivity. The infection joins, the process of decay starts. This is accompanied by intoxication of the body: the body temperature rises sharply, chills, palpitations, sweating, lethargy, lethargy appear. The condition represents a threat to the life of the patient.
Treatment of lower extremity gangrene in diabetes mellitus
With the developed gangrene of the lower extremities, the only treatment that can save lives is amputation of the affected area. With wet gangrene amputation is carried out urgently, as infection can lead to sepsis and death of the patient.
With dry gangrene, preoperative preparation is carried out, aimed at improving blood flow above the level of the lesion, normalizing blood sugar levels, functions of vital organs, fighting infection, and adequate anesthetization of the patient.
The amount of amputation depends on the type of gangrene and the condition of the vessels and surrounding tissues. Most often, amputation of the fingers, one or more, less often - of the feet, is extremely rare - “high” amputations at the level of the thigh or tibia.
To prevent gangrene, as well as its recurrence, reconstructive and non-reconstructive surgery on the vessels, restoring blood flow in the damaged parts of the arteries, are of great importance. Artery prosthetics, shunting, angioplasty, stenting are performed.
In no case should you try to treat gangrene of the feet with diabetes mellitus with folk remedies, hoping to do without amputation, compress, rub ointment, warm, etc. This is life threatening, you may lose time, the pathological process will progress and lead to greater volume of operation.
Prognosis for gangrene of the lower extremities
The prognosis for gangrene of the lower extremities in patients with diabetes mellitus depends on the type of gangrene, the duration of the disease, the age of the patient, the condition of other organs and body systems, and the compensation of carbohydrate metabolism.
With dry gangrene, the prognosis for life is favorable with timely treatment.
With wet gangrene, the prognosis is dubious, worsens in elderly patients with diabetes mellitus, delay in seeking medical help. The prognosis for wet gangrene without treatment is unfavorable, the patient dies from the manifestations of infectious-toxic shock.
Prevention of gangrene
Prevention of gangrene with diabetes mellitus is the normalization of carbohydrate metabolism, cholesterol, normalization of blood pressure, eliminating bad habits, regular foot care, timely treatment of early manifestations of diabetic foot syndrome, unloading of the foot, if necessary.
Maintaining normal carbohydrate metabolism is the basis for the prevention of all complications of diabetes.
You must monitor your blood glucose daily at home with a glucometer. Twice a year, and more often if necessary, check the level of glycated hemoglobin, which indicates the compensation of diabetes. Do not forget about the daily diet and regular intake of glucose-lowering drugs or insulin injections.
Often in patients with diabetes mellitus, lipid metabolism is also impaired, the level of cholesterol, its fractions and triglycerides is elevated. The normalization of these indicators slows down the development of atherosclerosis and improves the condition of the vascular wall.
Bad habits aggravate the course of diabetes. Hypodynamia contributes to the development of obesity, increase blood glucose levels, muscle atrophy. During smoking, vasospasm occurs, which further increases circulatory insufficiency in the affected tissues. Alcohol abuse causes severe hypoglycemic states, worsens the condition of the pancreas and liver.
Regular foot care and exercise are something that every diabetic needs to do regularly.
Foot Care Tips
- Regularly inspect the stop. In the case of the appearance of corns, calluses, cracks, ulcers, changes in the condition of the nails (darkening, ingrowth, fungal infection), be sure to consult a doctor.
- Daily wash your feet with warm water and soap, you can do the bath, but in any case, do not steam out the feet. Rub gently rub the belltox and rough areas. After washing, apply a moisturizer on the feet, avoiding areas between the fingers.
- Carefully trim the nails, trying not to injure the skin of the finger.
- Do not cut off corns and corns with sharp razors, scissors, do not apply corn plasters.
- Wear comfortable shoes with a wide nose. Shoes must fit, without extraneous liners. If you experience difficulties with the selection of shoes due to the deformation of the fingers, consult a physician therapist with a request to pick up special orthopedic shoes.
- Perform exercises for the feet. They will strengthen muscles and improve blood circulation in the affected areas.
The timely start of treatment of diabetic polyneuropathy and angiopathy can significantly reduce the likelihood of developing gangrene. They use thioctic acid preparations, B vitamins, vascular preparations, antioxidants, drugs that reduce cholesterol in the blood and thin the blood.