Abstract
Twenty-eight cases of diabetic gangrene treated in the department of orthopedics during the period between 1977 and 1986 were reviewed. There were sixteen males and twelve females. Clinical appearance of diabetic gangrene was divided into three typical lesions, which consisted of ischemic gangrene, neuropathic ulcer and septic gangrerne. Our cases were composed of nine ischemic, six neuropathic and thirteen septic lesions. Ischemic lesion was caused by macroangiopathy, that was arteriosclerotic obstruction of the major vessels. Mean age of nine patients was 62.4 years, which was higher than the other two groups. Amputation was required for the treatment of ischemic gangrene. Minimal re-section of the toe or the foot would be preferable to preserve ambulation. In these cases, reoperations were common. An average number of the surgery for one case was three. We recommended better functional recovery by minimal amputation in spite of disadvantages of reoperation and a long stay in hospital. Neuropathic ulcer was caused by microangiopathy and/or neuropathy. Mean age of the cases was 51 years. The lesion responded well to conservative treatment. Wound was treated by debridement, cleansing and ultraviolet rays. Intravenous administration of prostagrandin E1 (PGE1) was combined in some cases. Septic gangrene usually followed ischemic gangrene or neuropathic ulcer, though it occur-red without precedent lesions in some cases. Septic lesion was also responded well to coservative treatment, which was the same wound treatment as neuropathic ulcer and administration of antibiotics and PGE1. But, in case of severe defect of the bone or the skin, amputation or skin plasty was necessary. Mean age of septic gangrene cases was 53.2 years. Regarding the prognosis, 700 of the all cases had recurrence of foot lesions. Motality rate of the twenty-two follow-up cases was 36%.
