Diabetic gangrene

Introduction to Diabetes Diabetes combined with gangrene of the extremities is a clinical manifestation of chronic, progressive acral ischemia, pain, numbness of the hands and feet, and ulceration. The main causes are large, small, microcirculation lesions, peripheral neuropathy and various injuries, resulting from co-infection. Diabetes gangrene mostly occurs in middle-aged and elderly people, male to female, the ratio of male to female is 3:2, the average duration of diabetes is about 10 years, the lower extremities of gangrene are more common, accounting for 92.5%, the upper limbs are rare, accounting for 7.5%, unilateral incidence About 80%, bilateral onset of about 20%, toe and foot gangrene at the same time, accounting for 77.5%, toe and calf at the same time gangrene accounted for 5%, only calf gangrene accounted for 5%, toe or finger The incidence accounted for 12.5%. basic knowledge Probability ratio: one of the complications of diabetes, the incidence rate of diabetes patients is about 1%-5% Susceptible people: no specific population Mode of infection: non-infectious Complications: diabetic foot

Causes of diabetes gangrene

Disease factors (55%):

The cause of diabetic gangrene is multifactorial. Diabetic neuropathy, peripheral vascular disease and microcirculatory disorder are the main causes, which may exist alone or in combination with other factors.

Other factors (45%):

Such as foot structural malformation, abnormal gait, skin or nail deformity, trauma and infection are also important causes of diabetic foot.

Diabetes gangrene prevention

Overall prevention: adjust diet, control blood sugar; moderate exercise; spiritual pleasure; regular life; do not smoke; do not drink.

Local prevention:

Sixth

Keep your feet clean. Wash your feet carefully every day, regularly use alcohol to disinfect the feet, especially white mold, infiltration, foot scales, etc. to use fungal drugs to treat them in time.

Check your feet every day. Whether there is swelling or damage, pay attention to the color temperature of the skin.

It is necessary to trim the toenails in due course. Care should be taken to prevent damage to the skin when trimming. If it is broken, it should be disinfected immediately.

To prevent trauma, burns, frostbite.

Pay attention to the foot care during the action and choose the right footwear.

Always go to the hospital to check your feet. Through the examination of a specialist, you can understand the state of your feet, whether there are neurological or vascular lesions, which is very important for the diagnosis and prevention of diabetic foot.

Six

Don't walk barefoot. Patients with diabetes and peripheral vascular disease should prevent the injury of the foot and not walk barefoot, especially the pebble road for fitness in the community, which is not suitable for them;

Do not wash your feet with hot water. Usually the temperature of the foot washing should not exceed 40 ° C, and can not be heated with a hot water bottle or direct fire;

Do not wear inappropriate shoes and socks. You can wear cotton socks, soft and breathable shoes, otherwise it will cause foot damage or cause ankles;

Do not use harmful drugs. Especially some very irritating drugs;

Do not overly itching. Do not handle corns or self-use blades.

Diabetic gangrene complications Complications

Limb necrosis.

Diabetic gangrene symptoms Common symptoms Foot gangrene, gangrene, dry gangrene

1, intermittent claudication, for the early performance of the lower limbs, lower limb ischemia to make the muscles insufficient blood supply, walking a distance after the lower limbs fatigue, fatigue and numbness. In severe cases, there is pain in the lower leg gastrocnemius muscle, and the symptoms can be relieved after stopping walking or resting. Older people are highly suspected of lower limb ischemia caused by arterial occlusion if intermittent claudication occurs.

2, rest pain, is the mid-term manifestation of the lesion, when the lesion develops, the lower limb ischemia aggravates, does not walk also occurs pain, known as rest pain. This pain is mostly confined to the toe or the distal end of the foot. Especially at night, the pain in the lying position is aggravated, the lower extremity can be relieved, and the resting pain or rest pain at night. Because of the least cardiac output during sleep, the amount of blood injected into the lower extremities is also reduced, so the pain often worsens at night.

Diabetes gangrene check

Laboratory inspection:

1. Determination of fasting blood glucose, 2 h postprandial blood glucose and glycated hemoglobin (HbA1c).

2. Urine routine, urine sugar qualitative and 24h urine sugar quantitative, urine protein and ketone body examination.

3. Blood picture check RBC, HB, WBC.

4. Blood rheology examination.

5. Blood lipids check total cholesterol, triglycerides, high density and low density lipoprotein and plasma proteins, albumin, globulin, urea nitrogen or non-protein nitrogen.

6. Bacterial culture of gangrene secretions.

Other auxiliary inspections:

1. Electrophysiological examination EMG, nerve conduction velocity measurement, evoked potential and other tests can quantitatively evaluate the extent of peripheral nerve lesions and neuropathy in the lower extremities.

2. Measurement of skin temperature After exposure of the limb for half an hour at room temperature of 20 ° C to 25 ° C, the skin temperature of the toe face, the back of the foot, the toes and the calves was measured by skin thermometer symmetry. Normal skin temperature is 24 ° C ~ 25 ° C, lower extremity vascular disease, skin temperature is reduced, such as the temperature of the lower limbs or foot skin asymmetry, the difference 2 ° C, suggesting low temperature side lower extremity vascular lesions.

3. Walking distance and time measured the lower limb pain after walking for a certain period of time, but the pain can be relieved or relieved when walking, suggesting that the blood vessel is slightly blocked; the pain occurs after walking, and the walking pain continues to be relieved and is forced to stop, suggesting that the blood vessel is in the blood vessel. Degree of blockage; a little bit of walking occurs pain in the lower extremities and is forced to stop, suggesting severe vascular disease.

4. Determination of venous filling time The limbs are raised for a few minutes, the venous blood is emptied, and then quickly lowered to fill the arterial blood. Normally, the dorsal vein of the foot should be filled within 5 to 10 s; if it is greater than 15 s, it indicates that the arterial blood supply is insufficient; filling in 1 to 3 minutes, indicating that the arterial blood supply is significantly reduced, and the collateral circulation blood supply is poor, indicating that the ulcer is not easy to heal or easy. Causes gangrene of the limbs.

5. Blood pressure index It is a non-invasive examination, which has certain reference value for the judgment of lower extremity arterial stenosis and ischemia. The systolic blood pressure of the brachial artery was measured with a common sphygmomanometer, and then the sphygmomanometer cuff was placed above the ipsilateral ankle joint. The stethoscope was placed on the medial side of the medial malleolus to hear the pulsation of the posterior tibial artery; To the anterior tibial artery pulsation; the radial artery pulsation can be heard on the posterolateral side of the lateral malleolus. The ratio of systolic blood pressure of the brachial artery/radial artery (/ ratio) is 1 to 1.4 for normal people. <0.9 indicates that there is mild blood supply in the lower limbs, 0.5 to 0.7 may have intermittent claudication, and 0.3 to 0.5 may have ischemic rest pain. <0.3 A limb ischemic necrosis can occur.

6. Doppler ultrasound can detect the lesions of the femoral artery to the dorsal artery of the foot, can understand the condition of atherosclerotic plaque, the thickness of the intima, the degree of stenosis of the lumen, the blood flow per unit area and the acceleration of blood flow and Deceleration, etc., can be used to locate and quantify vascular lesions. However, due to the different types and methods of operation used in each laboratory, the data and results obtained are not identical. The application should refer to the respective normal control population.

Hyperthyroidism microcirculation was used to measure vasospasm morphology, blood vessels, blood flow status and velocity, and whether there were bleeding, congestion, exudation and other lesions (Table 3). When the microcirculatory disorder is observed: 1 tube sputum is reduced, arterial end is thinned, and abnormal shape tube sputum and sputum congestion are >30%. 2 The blood flow rate is slow, and it is a granular flow, a sediment-like flow, and a bead-like flow. 3 There are bleeding and exudation around the tube. Local skin microcirculation measurements of the limbs can be seen in the early stage of limb arterial occlusion.

7. Measurement of trans-cutaneous oxygen partial pressure (TcPO2) The Clark electrode was placed in the skin of the foot at a temperature of 43 ° C to 45 ° C. The height of TcPO2 was related to ischemia and hypoxia of the skin. Normal human TcPO2 is close to arterial oxygen partial pressure (PaO2), such as TcPO2<4.0kPa, suggesting that skin ischemia is obvious, local ulcer is difficult to heal; after inhaling 100% oxygen for 10min, if TcPO2 is increased by 1.3kPa (10mmHg) or more, Prompt prognosis is acceptable.

8. Arteriography is often used to understand the location of vascular lesions and the extent of lesions prior to amputation or revascularization, but the examination itself can lead to vasospasm and aggravate limb ischemia. In addition, if patients with proteinuria with or without renal insufficiency, contrast agents may aggravate renal insufficiency, should be used with caution, should be fully hydrated before angiography.

9. X-ray examination can find extremity osteoporosis, decalcification, osteomyelitis, bone and joint disease and arteriosclerosis, and also help to detect soft tissue changes in gas gangrene.

Diagnosis and diagnosis of diabetic gangrene

More often after the age of 50, 60-70 years old is more common. Diabetic patients who are more common in obese or adult type and have a long course of disease, on average, about 10 years. The lower extremities are more common in the area, and the upper limbs are rare. The incidence of unilateral onset was 80%, and bilateral onset was rare at 20%. Gangrene can occur suddenly, and the pain is severe. Most patients with gangrene are slow, with severe neurological damage, pain can be light and heavy, local mild injury, and skin-constrained small blisters. After the subcutaneous tissue becomes dark red or black, severe limbs and feet are ulcerated and necrotic, dry and black, and purulent infection.

Differential diagnosis

Wet gangrene

Local soft tissue erosion of the extremity surface forms a shallow ulcer, followed by ulceration deep into the muscular layer, even the broken tendon, bone destruction, massive tissue necrosis, formation of a large abscess, discharge of more secretions. This type of gangrene is more common, accounting for 72.5%. The main pathological basis is microcirculatory disorder caused by thickening of microvascular basement membrane.

Dry gangrene

Avascular necrosis of the affected extremities, dry and black, the boundary of the lesion is clear, and it will fall off spontaneously without treatment. This type of gangrene accounts for about 7.5%, and its main pathological basis is ischemic necrosis caused by occlusion of small and medium arteries.

Mixed gangrene

About 20%. Microcirculatory disorders and small arterial occlusions coexist, with both ischemic and dry necrosis of the extremities and wet gangrene of the feet and/or calves.

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