DIABETIC GANGRENE

Diabetic gangrene is a term applied to those cases of cutaneous
gangrene which are directly or indirectly due to the presence of diabetes,
of which many examples have been recorded (Kaposi, Rosenblatt, and
others).²

Symptoms.—Diabetic gangrene may show itself spontaneously
without previous injury to the affected skin, or it may arise at the seat of
a slight traumatism, or even at the seat of the skin affections, so common
in such subjects.

In those cases arising spontaneously there may be prodromal symp­
toms of loss of sensation, neuralgic pain, and coldness of the part, and
sometimes intermittent flushing or lividity of the area. Gradual death
of the integument may ensue, the part first becoming dark colored, or
there is at first the appearance of vesicles or blebs. The destruction may
extend into the subcutaneous tissue, and it also tends to spread laterally.
One, several, or more patches may be present, and in some cases the areas
are arranged somewhat symmetrically.

In other cases of diabetic gangrene starting from traumatism the
part either rapidly goes into a state of gangrene, which may be dry or
moist, but usually the latter, and tends to spread and involve the deeper
tissues; or the traumatism may first be followed by inflammatory action,
which later becomes gangrenous. In this variety those parts liable to
injuries or knocks, such as the legs and hands, are most commonly the
seat of the malady, especially the former.

The patches in diabetic gangrene are rounded, irregular, or even
serpiginous. Constitutional disturbance may or may not be present in
the beginning; symptoms of septic character usually finally supervene.

¹ Fordyce and Mewborn (“ A Case of Undetermined Infection of the Skin, Possibly
Glanders”), Jour. Cutan. Dis., 1903, p. 549, and Wende and Bentz, “Infectious Derma­
titis Gangrænosa,” ibid., 1906, p. 445, describe 2 cases (1 in each paper, with illustra­
tions) of gangrenous infection of the skin, with death following; the cases were some­
what suggestive of glanders, but investigations as to this point were negative.

²Kaposi, “Hauterkrankung bei Diabetikern,” Wien. med. Wochenschr., 1884, Nos.
1, 2, 3, and 4; C. W. Allen, Med. News, Oct. 24, 1897. See also paper by Morrow,
“The Cutaneous Manifestations of Diabetes,” Med. Record, April 11, 1896. Other
references will be found under General Etiology.

432

INFLAMMATIONS

Etiology and Pathology—Considering the number of cases of
diabetes, diabetic gangrene must be considered extremely rare. Three
factors are doubtless contributory or essential in its production: The
abnormal impregnation of the tissues and blood with sugar, making the
former favorable soil for microbic development; lessened resisting power,
superinduced by the diabetes; and microbic infection, probably taking
place through some break in the continuity of the skin. Gussenbauer¹
inclines to the belief that the gangrene is not so much due to the sugar
in the tissues, as to the loss of resisting power and to the bad effects
following infective processes in such individuals. The spontaneous
form is possibly purely trophic in origin, but in these cases an unnoticed
insignificant injury or break in the skin may have preceded. Morrow
states that it mainly occurs in the old and obese, is usually of the moist
type, and that the blood-vessels are found to be pervious. Wallace²
found the arteries in 23 out of 24 cases decidedly atheromatous, the
patients averaging sixty-three years; and that the disease was relatively
more frequent in males.

Prognosis and Treatment.—The disease is a grave complication
or accident in the course of a serious disease, and the outlook is rendered
less favorable. The gangrene is apt to extend, and new areas may arise.
The patient may finally die from septic poisoning. Exceptionally
cases do recover, however, particularly those of spontaneous origin.

The diabetes itself must be carefully treated, both by dietetic and
medicinal means. The gangrenous spots or areas are to be managed
upon general principles, with applications of antiseptics, until the slough
separates; or, better still, as soon as the slough has formed it may be
removed by curetting, if necessary, and the parts treated antiseptically.
Gussenbauer points out that the best plan consists in thorough surgical
removal of the diseased tissue. Wallace believes the best treatment is
removal of the limb early, before sepsis has caused great depression.

But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy!

Also, please consider sharing our helpful website with your online friends.