Limb Salvage Treatment for Diabetic Gangrene

Abstract

95% of foot gangrene is caused by arteriosclerosis obliterans (ASO). More than 80% of ASO are attributed to diabetes, and more than 60% of patients with diabetes are on hemodialysis (HD). Another 10% of foot gangrene are led by collagen vascular diseases, such as rheumatoid arthritis and scleroderma, Buerger's disease, and shaggy aorta syndrome. These are accompanied by severe rest pain. The progression of foot gangrene results in major limb amputation. Recently, major limb amputation has most affected patients with diabetes and/or on HD.

Foot gangrene can be ischemic, neuropathic, and mixed (ischemic and neuropathic). Ischemic type is not common. Neuropathic type is accompanied by various sensory impairments, and increases the risk of deformities in toes and limbs and susceptibility to infection. Mixed type is most common (60%). The combination of ischemia and neuropathy accelerates the progression of infections and gangrene, which helps to prevent infection management and increase the risk of major amputation.

None of patients want major limb amputation. Loss of limbs in patients leads to deteriorating quality of life (QOL). Current comprehensive limb salvage treatment, including arterial reconstruction, wound management, and tissue transfer surgery for DM gangrene will acceptably achieve limb salvage rate by over 90% in 5 years. To standardize the treatment, it is urgent to establish a training program of limb salvage for physicians and surgeons.