Gangrene Localized to the Lower Limbs in Diabetics

Abstract

Over a 8 yr, 247 unselected patients with more or less widespread areas of obvious cutaneous erythema on the lower legs and/or feet (incipient gangrene) or corresponding areas with cutaneous necrosis (manifest gangrene) were examined. Of these patients, 34% had incipient and 66% manifest gangrene. Seventy-five percent had open diabetes; the others were classified as non-open diabetics. In 75% of the 247 patients these lesions accompanied cardiac decompensation with or without edema, edema of other causes or, in some cases, arterial insufficiency. The gangrene developed in most patients a short time after the onset of these precipitating factors. Arterial insufficiency alone or together with other precipitating factors was seen considerably less often. Edema was thus the main precipitating factor for these lesions. Cardiac decompensation as well as edema of the legs due to other causes respond well to treatment. When treating such patients with open or non-open diabetes, it should be taken into consideration that gangrene is a serious condition.