CONSERVATIVE AND SUCCESSFUL TREATMENT OF DIABETIC FOOT GANGRENE

Abstract

Clinical and therapeutic responses of three patients suffering from severe diabetic foot gangrene are described. All patients had progressively enlarging foot ulcers exuding a putrid odor associated with extensive cellulitis. Roentgenograms showed osteomyelitis in two of them. Diabetic neuropathy was present in all patients. All three patients were strictly treated with subcutaneous injections of regular insulin four time a day to maintain plasma glucose levels of 70-150mg/dl through 24 hours. Incisions were made to drain the lesions and exudate was thoroughly debrided. Response to the treatment was excellent and cure with scars was achieved in all patients in three to four months. Ischemia, peripheral neuropathy and infection are the major factors leading to diabetic foot gangrene. Neuropathic gangrene is generally curable by conservative therapy, but the patient is occasionally treated erroneously by amputation, which is often carried out in patients with angiopathic gangrene. Therefore, from therapeutic and prognostic viewpoints, it is important that differential diagnosis of neuropathic and angiopathic gangrenes should be precise. Strict control of plasma glucose levels and drastic topical treatment are indispensable for patient with diabetic foot gangrene.