Al Wahbi Abdullah
King Saud University for Health Sciences, Division of Vascular Surgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Diabetes Metab Syndr. 2019 Mar-Apr;13(2):959-963. doi: 10.1016/j.dsx.2018.12.021. Epub 2018 Dec 27.
Diabetic foot is a major comorbidity of diabetes, with 15-25% of diabetic patients developing diabetic foot ulcer during their lifetime. Other major diabetic foot complications include cellulitis, abscess, wet gangrene, dry gangrene, and necrotizing fasciitis. Dry gangrene involves tissue necrosis due to chronic ischemia whereby the tissue becomes numb, dry, wrinkled, and dead. Although diabetic foot complications have been extensively studied in literature, there is limited data on the management of dry gangrene.
We report a case series of 12 patients with diabetes-related dry gangrene in the toes, initially planned to be managed conservatively with autoamputation.
One patient had an autoamputation, while eight patients underwent surgical amputations (six major amputations, two minor amputations) for better clinical outcomes. Two patients died, while no change was observed in one patient even after 12 months of follow-up.
Managing diabetic dry toe gangrene by waiting for autoamputation may lead to worse clinical outcomes and should be practiced cautiously on a case-by-case basis. Early surgical intervention should be opted to improve patients' quality of life.
糖尿病足是糖尿病的一种主要合并症，15% - 25%的糖尿病患者在其一生中会发生糖尿病足溃疡。其他主要的糖尿病足并发症包括蜂窝织炎、脓肿、湿性坏疽、干性坏疽和坏死性筋膜炎。干性坏疽是由于慢性缺血导致组织坏死，从而使组织变得麻木、干燥、起皱并坏死。尽管糖尿病足并发症在文献中已得到广泛研究，但关于干性坏疽治疗的数据有限。
我们报告了一组12例糖尿病相关足趾干性坏疽患者的病例系列，最初计划采用自行截肢的保守治疗方法。
1例患者自行截肢，8例患者为获得更好的临床结局接受了手术截肢（6例大截肢，2例小截肢）。2例患者死亡，1例患者即使在随访12个月后也未出现变化。
等待自行截肢来处理糖尿病足干性坏疽可能会导致更差的临床结局，应根据具体情况谨慎实施。应选择早期手术干预以提高患者的生活质量。
