Complication of glycation: Limb salvage treatment for diabetic gangrene

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  • 糖化の果てに：糖尿病性足壊疽に対する救肢治療

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Abstract

<p>Before 2000, incidence of arteriosclerosis obliterance (ASO) associated with diabetes mellitus (DM) was only about 30%. Currently, the main etiology of ischemic foot gangrene is ASO in 95%, and, with prevalence of DM, over 80% of ASO patients are diabetic, and 60% are dialysis-dependent (HD). ASO seen in DM patients is characterized by multi-segmental stenosis and occlusion in the infra-popliteal arteries, and commonly associated with disorder of microcirculation due to peripheral autonomic neuropathy, and extensive arterial calcification. The pathophysiology in DM foot may lead to extensive gangrene, which is nowadays the main cause of major amputation. Infection without ischemia due to arterial lesions may cause extensive foot gangrene, while, if the patients have mild ischemic foot with infection, both disorders produce a great combined effect, resulting in extensive tissue necrosis. In these situations, inadequate management of the foot gangrene may lead to major amputation.</p><p>In this context of DM foot gangrene, our 5-year limb salvage rate after bypass surgery in DM patients with foot gangrene is 94%, and leading centers have achieved excellent outcomes. Our results demonstrated that if patients remain independent ambulatory function before onset of foot gangrene, most of the patients commonly retrieved physical functioning after limb salvage even in patients with extensive tissue loss. Therefore, ambulatory function before limb salvage treatment is important factor influencing outcomes of limb salvage treatment.</p>

Journal

  • Comprehensive Medicine

    Comprehensive Medicine 18 (1), 14-21, 2020-01-25

    International Foundation of Comprehensive Medicine

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