A Diabetic Patient with Gangrene of the Finger

Abstract

Almost all symptoms of diabetic gangrene have so far been noted in the lower extremities. Their occurrence in the upper extremities is reported to be very rare. Recently, however, we treated one diabetic patient who had a spot of gangrene in the finger.
The patient, a 50-year-old male, has suffered from diabetes for the last 7 years. He has been treated with oral hypoglycemic agents for the last 2 years, since.July 1977. In August, 1977, when gangrene first occurred, he was injured slightly in the fourth toe of the left foot, but it was soon cured. A year later, in August, 1978, a rose thorn pierced and entered the tip of the fourth finger of the right hand, and gangrene again appeared. Angiography revealed complete obstruction at the ulnar artery, with blood flow to the fourth and fifth fingers supplied by collateral flow through the interosseous and radial arteries.
Burger's disease was suspected because of the patient's smoking history, the regions in which the symptoms occurred, and rather deficient angiographic findings for atherosclerotic lesions. However, there was a background of diabetic microangiopathy and neuropathy, and the patient was diagnosed as diabetic gangrene based on the manner of cure and reduction of pain through the use of insulin, although the patient continued smoking, and the fact that the gangrene had been triggered by a wound, and spot-like findings were obtained by thermography.
A switch was made from oral hypoglycemic agents to insulin injection, performed in combination with local insulin pack therapy. Antibiotics and peripheral vasodilators were also administered concomitantly. About 6 months later, in January, 1979, the gangrene was cured, and no relapse had occurred as of June, 1979.