What Is Diabetic Gangrene?

Occurs after 50 years old, more common in 60-70 years. It is more common in obese or adult patients with long-term diabetes, with an average of about 10 years. More common in the lower extremities, but rare in the upper extremities. It is 80% more common in unilateral cases and 20% less common in both sides. Gangrene can occur suddenly and the pain is severe. In most patients, the occurrence of gangrene is slow, with severe nerve damage, pain can be mild or severe, local mild damage, and localized small blisters. Later, the subcutaneous tissue becomes dark red or black, severe ulceration and necrosis of limbs, hands, and feet, dryness and blackness, and purulent infection. ^[1]

Diabetic gangrene

Diabetic gangrene mostly occurs in middle-aged and elderly people; there are more males than females, and the ratio of male to female is 3: 2. The average duration of diabetes is about 10 years. The gangrene site is more common in the lower limbs, accounting for 92.5%, and the upper limbs are rare, accounting for 7.5%. About 80%, bilateral simultaneous incidence of about 20%; toe and plantar gangrene are common, accounting for 77.5%; simultaneous toe and calf gangrene accounts for 5%, only calf gangrene accounts for 5%; toes or fingers The incidence was 12.5%.

Clinical manifestations of diabetic gangrene

Signs and symptoms of diabetic gangrene

Diabetic gangrene symptoms

1. Intermittent claudication is an early manifestation of the lower limbs. Ischemia of the lower limbs causes insufficient blood supply to the muscles. After walking a certain distance, the lower limbs are fatigued, tired and numb. In severe cases, there is pain in the calf gastrocnemius, which can be relieved after stopping walking or resting. Elderly people with intermittent claudication are highly suspected of having lower limb ischemia due to arterial obstruction.

2. Pain at rest is the mid-term manifestation of the lesion. When the lesion develops, the lower limb ischemia worsens, and pain also occurs without walking, which is called resting pain. This kind of pain is mostly confined to the toes or the feet, especially at night. The pain intensifies in the lying position. The lowering of the lower limbs can be relieved, and the pain at rest or rest at night. Because the cardiac output is the smallest during sleep, and the lower extremity perfusion is reduced, the pain often worsens at night.

Types of Diabetic Gangrene

There are three clinical types of diabetic limb gangrene: dry gangrene, wet gangrene, and mixed gangrene.

Diabetic gangrene

Local soft tissues on the extremities erode, forming shallow ulcers, followed by ulceration deep into the muscle layer, and even rotten tendons, bone damage, massive tissue necrosis, formation of large pus cavities, and discharge of more secretions. This type of gangrene is more common, accounting for 72.5%. The main pathological basis is microcirculatory disturbance caused by the thickening of the microvascular basement membrane.

Diabetic gangrene

The ischemic necrosis of the affected limb ends, dryness and blackness, the lesion boundary is clear, and it will fall off without treatment in a certain stage. This type of gangrene accounts for about 7.5%, and its main pathological basis is ischemic necrosis caused by small and medium arterial occlusion.

Diabetic gangrene

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

Classification of diabetic gangrene

Grade 0: No open lesions, apparently insufficient blood supply.

Grade I: Superficial ulcer. Can be caused by blisters or other injuries, or spontaneously.

Grade II: ulcers deep into tendons, ligaments, bones and joints.

Grade III: Deep ulcer infection with osteomyelitis and abscess sinus formation.

Grade IV: Gangrene with toe and / or part of the foot.

Level : full foot gangrene.

Prevention of Diabetic Gangrene

Holistic prevention: adjust diet, control blood sugar; exercise moderately; mental pleasure; regular life; do not smoke; do not drink.

Local prevention:

Six Essentials of Diabetic Gangrene

Keep your feet clean. Wash your feet carefully every day, and regularly disinfect your feet with alcohol, especially white mold and infiltration on the toes, and use scale-killing drugs to treat the feet in a timely manner;

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

Trim toenails in a timely manner. Pay attention 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 foot health while in action and choose appropriate footwear.

Always go to the hospital to check your feet. Through the examination of a specialist, you can understand the status of your feet and whether there are neurological or vascular lesions. It is very important to diagnose and prevent diabetic feet.

Diabetes gangrene

Don't walk barefoot. Patients with diabetes and peripheral vascular disease must prevent foot injuries and cannot walk barefoot, especially the cobble road for fitness in the community, which is also inappropriate for them;

Do not wash your feet with hot water. The temperature of foot washing should not exceed 40 ° C, nor can it be heated by hot water bottles or by direct fire;

Do not wear inappropriate footwear. You can wear cotton socks and soft and breathable shoes, otherwise it will cause foot injury or cause athlete's foot;

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

Don't over-itch. Do not handle corns or cut yourself with your own blade.

Care of Diabetic Gangrene

Actively control diabetes. Patients with diabetic foot necrosis consume a large amount of infection due to infection, and should appropriately increase calories by 10% -20%, according to the patient's eating habits, diversify the recipe. Adjust the insulin dose according to blood glucose changes to control blood glucose to near normal levels.

Improve local blood circulation. Local skin care: Keep your feet clean and dry. Soak your feet in soft soap and warm water at 39 ° C-40 ° C for 20 minutes every day, then gently wipe the skin of your feet with a soft towel. People with sweaty feet can apply some talcum powder between the toes; while those who are particularly dry apply skin care products properly, apply to the surface of the feet (not between the toes), do not scratch the skin itching or athlete's foot; foot massage Several times a day, gentle movements, starting from the toes should be massaged upwards to promote blood circulation to the affected limb; patients' socks should be loose and comfortable. Due to the skin microcirculation disorder, keep warm at the extremities when it is cold, but avoid using hot water bottle to keep it warm to prevent scalding and blistering. People with foot infections can use traditional Chinese medicine to soak their feet, take Wenyang Yiqi, Huoxue Tongmai, and detoxify the traditional Chinese medicine Wenhuo for 20 minutes, and soak the feet when the temperature drops to about 50 ° C. Skin blister care: If there is blisters and athlete's foot, you can use 1: 5000 potassium permanganate solution to soak your feet 3 times a day, not more than 1 week. Keep the blisters clean, avoid incisions on tension blisters, and extract exudate under aseptic operation to prevent secondary infection.

Proper foot exercise. Do proper calf and foot exercises daily for 30 to 60 minutes, such as leg throws, heel-toe exercises, and squat exercises. Elevating the affected limb normally to facilitate blood flow can improve blood circulation in the lower limbs.

Treatment of Diabetic Gangrene

1. Albumin: After debridement according to the degree of gangrene, rinse with physiological saline, take the remaining albumin moistened gauze and cover the wound surface, and change the dressing 3 to 4 times a day. The secretion is reduced, the wound is clean, and there is blood infiltration when touched. When changing out, change the dressing 1-2 times a day, and use gauze to protect it after recovery. This medicine has the functions of local nutrition, anti-inflammatory and promoting wound healing.

2. Amino acid solution: Take the amino acid solution and physiological saline and prepare for use. 4 layers of sterile gauze were soaked with a chemical solution and applied to the wound, then covered with a plastic film and fixed with adhesive tape, and replaced twice a day.

3. Zhu's Wound Healing Cream: Prescribed for traditional Chinese medicine. Chinese medicine preparation for treating bedsore. It has obvious bacteriostatic effect, enhances the body's resistance to pathogens, and exerts its effects such as eliminating evil and replenishing, anti-inflammatory and detoxification, going out toxins, reducing swelling and analgesia, removing saprophytic muscle and accelerating local blood circulation, and promote fibroblast growth and promote The wound heals quickly.

4. "Special Effect Decubitus Powder" of Jinyuantang: It also has obvious antibacterial effect, eliminates tissue edema, anti-inflammatory, keeps granulation fresh, and promotes wound healing. It has obvious curative effect on the refractory gangrene that is unhealed. .

Traditional Chinese Medicine for Diabetic Gangrene

If diabetes is not satisfactorily controlled for a long time, blood sugar is too high, and glucose metabolism cannot meet the physiological needs of the human body, the human body will use stored fat to provide energy. A large number of products of fat metabolism will be deposited on the blood vessel wall. Due to lack of insulin, diabetic patients will accelerate protein metabolism, increase auxin, and increase immune complexes. These will cause microvascular endothelial damage, cause microcirculation disorders, and in a hyperglycemic environment. Hemoglobin reduces the ability to exchange glycosylated oxygen, resulting in tissue hypoxia. Causes narrowing or obstruction of the lumen of large blood vessels in the lower limbs; Hyperglycemia and microcirculation disorders can also cause peripheral nerve dysfunction, which can cause necrosis when severe ischemia of the extremities; At the same time, high blood glucose provides good nutrition for bacteria, and it is easy to cause infection and appear Local ulceration. Necrosis combined with infection leads to diabetic gangrene (diabetic foot). In this process, due to ischemia and hypoxia, a large number of acidic metabolites are produced, and the normal pH value of the human body is between 7.35 and 7.45, becoming weakly alkaline. However, too much acidic substances (fat metabolism produces fatty acids, protein metabolites are amino acids, and carbohydrate metabolism produces gluconic acid) will make the pH of body fluids low and gradually acidify. Enzyme activity decreases. For every 0.1 pH drop in the human body, insulin utilization decreases by 30%, glucose utilization in the blood decreases, and blood glucose rises naturally.

Dialectical classification of traditional Chinese medicine for diabetic gangrene

(1) Cold blood stasis and choroidal block

Clinical manifestations Limb gangrene, dark in color, less exudate from the wound, coldness in the limbs, pain, numbness, dull feeling, pale skin, thin white tongue coating, dark red tongue, and weak veins.

[Symptoms and signs] The disease is cold blood stasis, choroidal blockage, due to congestion and choking, choroids, ischemia, acne gangrene, dark purple, limbs cold and cold, pain numbness, dull feeling, pale skin, tongue coating Thin white, dark red tongue, weak veins.

(2) Damp-heat bet, internal stasis syndrome

Clinical manifestations Limb gangrene, festering flesh rot, purple color, more exudate from the sore surface, limb swelling, severe pain, redness of the skin, yellow urine, dark red tongue, yellow greasy fur, and number of pulses.

Differentiation analysis The pathogenesis of this card is damp-heat betting, blood stasis internal resistance, due to damp-heat blood stasis, inaccessible veins, local loss of nutrition, gangrene of the limbs, ulcerated meat rot, purple color, and more exudate on the sore surface. Damp heat bet, so the patient's limbs are swollen, the pain is intense, the skin is red, the urine is yellow and red, the tongue is dark red, the fur is yellow and greasy, and the number of pulses is small.

(3) Heat poisoning, Yin and blood stasis syndrome

Clinical Symptoms Limb gangrene, fleshy erosion, burning and soreness, purulent exudation on the sore surface, obvious dark purple, accompanied by high fever, dizziness, and thirst. The tongue is dark, yellow and dry, and the veins are thin.

[Symptoms and signs] The pathogenesis of this disease is heat toxin, blood stasis, internal congestion, so gangrene of the extremities, severe pain, and hot internal rot, so the meat rots and the heat is hot, so drink more thirsty. Burning and swelling, purulent exudation on the sore surface. Heat Sheng Yin injury, so the tongue is dark, yellow and dry fur, pulse count.

(4) Qi and Yin deficiency, severe injury to blood stasis syndrome

Clinical manifestations Festering ulcers, no new meat, slow healing, patients with dry skin, muscle atrophy, or dizziness, fatigue, dry mouth, astringent eyes, dark tongue, weak or thin pulse.

Differentiation analysis This card is in the late stage of gangrene, with both qi and yin injuries, and blood stasis due to qi and yin deficiency. Due to qi and yin deficiency, congestion internal resistance, extremities ulceration, righteous Qi failure, insufficient blood, so new blood is not born. The meat is not long, the healing is slow, the skin is dry, and the muscles are atrophic. Qi and blood deficiency, vomiting dizziness, weakness, dry mouth, astringent eyes. Zhengxue blood stasis, qi and yin injuries, so the tongue is dim, the pulse is weak or astringent.

No matter what type of syndrome there is a common problem, the blood PH value decreases. In the course of treatment, according to the dialectical results, drugs that can lower blood sugar and adjust PH value are selected. Is currently the best treatment option.