Dry necrosis of fingertips

Introduction The mild dry gangrene stage of diabetic gangrene is characterized by focal necrosis of the distal end of the finger and foot or the skin of the foot.

Cause

The main cause of acral ischemia in diabetic patients is arterial or venous lesions, which leads to blood flow. The clinical symptoms and signs produced by different blocked parts are different, and the clinical manifestations of acute obstruction and chronic obstruction are also different. However, their prognosis can cause acral ischemia, gangrene or necrosis.

an examination

Related inspection

Bacteriological examination of blood glucose

Combined with foreign grading standards, the degree of diabetic gangrene lesions was divided into 6 grades.

Grade 0: There is no open lesion in the skin. It is characterized by insufficient blood supply to the extremities, cold skin, purplish or pale, numbness, dullness or loss. Stinging or burning of the extremities, often with high-risk feet such as deformities of the toes or feet.

Level 1: There is an open lesion in the skin of the extremities. Superficial ulcers caused by blisters, blood bubbles and corns, frostbite or burns and other skin damage, but the lesions have not affected deep tissues.

Level 2: The infected area has already invaded deep muscle tissue. Often mild cellulitis, multiple pus and sinus formation, or infection along the muscle space, resulting in foot, foot and back ulcers or gangrene, more purulent secretions. Foot or finger toe skin focal dry gangrene, but the tendon ligament is not damaged.

Level 3: destruction of the tendon ligament tissue. Cellulitis combines to form a large abscess, purulent secretions and necrotic tissue, foot or a few fingers (toe) dry gangrene, but bone destruction is not obvious.

Grade 4: Severe infection has caused bone destruction, osteomyelitis, bone and joint destruction or formation of pseudo-articular joints, summer joints, wet or dry gangrene or necrosis in some hands and feet.

Grade 5: Most of the foot or the foot is infected or ischemic, resulting in severe wet or dry gangrene, blackened limbs, corpse, often affecting the ankle and calf. Amputation is usually required.

Differential diagnosis

Differential diagnosis of dry necrosis of the toe:

1. Dry toe at the toe: Dry toe at the toe is one of the symptoms of occlusive thromboangiitis. Thrombosis angiitis obliterans (tao) is a kind of vascular inflammation that is different from arteriosclerosis and segmental distribution. The lesions mainly involve the middle and small arteries and veins of the distal extremities. The pathological features are mainly characterized. Inflammatory cells infiltrate thrombus, and less involved in the vessel wall.

2, foot gangrene: diabetic foot lesions refers to: diabetic patients due to vascular disease caused by insufficient blood supply, due to neuropathy caused by sensory loss and infection with foot changes. Patients who have amputated for diabetic foot disease are 5 to 10 times more likely than non-diabetics. In fact, similar pathological changes can occur in other parts of the body, except that the incidence of foot lesions is significantly higher than in other areas. The main manifestations of diabetic foot are lower extremity pain and skin ulcers. From light to heavy, it can be intermittent claudication, lower limb rest pain and foot gangrene. In the early stage of the disease, the physical examination can detect the lack of blood supply to the lower limbs. For example, when the lower limbs are raised, the skin of the feet is pale, and when the lower limbs sag, it is purple-red. The feet are cold, and the dorsal artery pulsation weakens and disappears. Intermittent claudication is when the patient sometimes walks and suddenly feels pain in the lower extremities, and has to walk limping. Rest pain is the result of further development of lower extremity vascular disease. Not only does the lower limbs supply insufficient blood when walking, but also the lower limbs are painful because of blood. In severe cases, patients can sleep at night. The disease develops further, and the lower limbs, especially the feet, can be necrotic, and the wounds are unhealed for a long time. In severe cases, they have to amputated to the disabled.

Early dry gangrene: often there is insufficient blood supply to the affected limbs, the patient is afraid of cold, the skin temperature drops, the limbs are dry, numbness or loss of feeling. Intermittent limp or rest pain, mostly persistent.

Dry gangrene at the beginning: common skin pale, bloody or bloody, frostbite and other super dry skin. It occurs mostly at the end of the toe or at the base of the foot.

Moderate dry gangrene: A small number of dry necrosis of the hand, foot and toe and foot roots have spread to deep tissues.

Severe dry gangrene: common multiple fingers or feet of the fingers or parts of the hands and feet from the purple color gradually grayish brown, and then become black necrosis, and gradually clear boundaries with healthy skin.

Severe dry gangrene: Most of the hands or feet become black and necrotic, showing charcoal-like corpses. Some patients have secondary infections, and there are purulent secretions between gangrene and healthy tissues.

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