Clinical Study on treatment of Diabetic Gangrene / 대한정형외과학회잡지

ABSTRACT

Diabetic gangrene is a common complication of diabetes mellitus, and its an incidence which has an increasing tendency. And its treatment is very difficult because of the high incidence of delayed wound healing. The diagnostic method to determine the level of amputation for treatment of ischemic limb was reported by many authors, but it still has many controversies. From January 1973 to December 1982, 60 cases in 55 patient of diabetic gangrene were treated at the Department of Orthopedic Surgery Severance Hospital. The result of treatment of diabetic gangrene according to the level of amputation, primary healing rates, and complication were studied. The results obtained are as follow; l. Among 55 patients, 34 male and 21 female, 50 patients(90.9%) were older than 51 years. 2. There was no correlation between primary healing and palpating arterial pulsation at the amputation level, also there was no correlation between primary healing and obstruction of proximal artery in arteriography. 3. It wasrecommended to correct hemoglobin level above 12.1gm% before treatment for primary healing at the operation site. 4. Debriment and skin graft were indicated with the grade I lesion. Whenever they amputate and attempt to do primary healing at the operation site, the ideal level is the site where the skin temperature is between 33.1℃ to 34℃. 5. High delayed healing rate(71.4%) was anticipated in below knee amputation with grade IV lesion with low skin temperature(below 32℃). 6. Among 12 patients who took Pylon prosthesis and started early weight bearing walking after major amputation, 10 patients(83.3%) were healed orimarily. 7. Operative mortality was 5.4% and 5 year mortality after operation due to diabetic gangrene was 16.9%.