Autoamputation of diabetic toe with dry gangrene: a myth or a fact?

Wahbi, Abdullah Al

doi:10.2147/dmso.s164199

Cited by 24 publications

(13 citation statements)

References 41 publications

(42 reference statements)

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“…Gangrene is often the cause of amputation in diabetic foot syndrome [ 29 , 30 , 31 ]. Sections E10.5–E14.5 indicate violations associated with microcirculation disorders.…”

Section: Discussionmentioning

confidence: 99%

Clinical Classification of the Diabetic Foot Syndrome Adapted to ICD-10 as a Solution to the Problem of Diagnostics, Statistics and Standardisation

Lukin¹,

Kuchumov

Zarivchatsky³

et al. 2021

Medicina

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Background and Objectives: To propose a new classification of diabetic foot syndrome adapted for inclusion in the ICD-10 (the ICD-10 is the 10th revision of the International Statistical Classification of Diseases) and providing more reliable data on the number of clinical cases. Materials and Methods: A randomized controlled trial was performed. A total of 180 patients (36.6%) discharged from the hospital after surgical treatment and 312 patients (63.4%) who applied independently were observed and analysed. All patients had type 2 diabetes and were comparable in gender, age, duration of diabetes, area and nature of the wound defect. Results: We proposed to add the following to the existing ICD-10 and the emerging ICD-11 codes: Edf10.0—insulin-dependent diabetes mellitus with diabetic foot syndrome and Edf11.0—non-insulin-dependent diabetes mellitus with diabetic foot syndrome, where “df” is an acronym for diabetic foot. The new classification designates the seven most frequent areas of the lesion and five degrees of depth of soft tissue lesions. Conclusions: The proposed classification adapted for ICD-10 will enable the standardisation of diagnosis, providing a complete picture of this complication of diabetes mellitus, determining the number of amputations and their validity. Accurate statistics will allow for objective funding and timely preventive measures.

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“…Gangrene is often the cause of amputation in diabetic foot syndrome [ 29 , 30 , 31 ]. Sections E10.5–E14.5 indicate violations associated with microcirculation disorders.…”

Section: Discussionmentioning

confidence: 99%

Clinical Classification of the Diabetic Foot Syndrome Adapted to ICD-10 as a Solution to the Problem of Diagnostics, Statistics and Standardisation

Lukin¹,

Kuchumov

Zarivchatsky³

et al. 2021

Medicina

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“…Once gangrene has developed, the affected tissue is no longer salvageable. The boundary of the dried lesion is sharply demarcated from the nonischemic skin so that autoamputation may follow [8]. Because of the lack of infection, dry gangrene is not so emergent as wet gangrene and gas gangrene.…”

Section: Dry Gangrenementioning

confidence: 99%

Pathology of Gangrene

Tsutsumi¹

2020

Pathogenic Bacteria

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Pathological features of gangrene are described. Gangrene is commonly caused by infection of anaerobic bacteria. Dry gangrene belongs to noninfectious gangrene. The hypoxic/ischemic condition accelerates the growth of anaerobic bacteria and extensive necrosis of the involved tissue. Clostridial and non-clostridial gangrene provokes gas formation in the necrotic tissue. Acute gangrenous inflammation happens in a variety of tissues and organs, including the vermiform appendix, gallbladder, bile duct, lung, and eyeball. Emphysematous (gas-forming) infection such as emphysematous pyelonephritis may be provoked by Escherichia coli and Klebsiella pneumoniae. Rapidly progressive gangrene of the extremities (so-called “flesh-eating bacteria” infection) is seen in fulminant streptococcal, Vibrio vulnificus, and Aeromonas hydrophila infections. Fournier gangrene is an aggressive and life-threatening gangrenous disease seen in the scrotum and rectum. Necrotizing fasciitis is a subacute form of gangrene of the extremities. Of note is the fact that clostridial and streptococcal infections in the internal organs may result in a lethal hypercytokinemic state without association of gangrene of the arms and legs. Uncontrolled diabetes mellitus may play an important role for vulnerability of the infectious diseases. Pseudomonas-induced malignant otitis externa and craniofacial mucormycosis are special forms of the lethal gangrenous disorder.

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“…Limb amputation (LA), the surgical removal of part of or an entire limb, is usually performed to prevent deterioration of an individual’s health [ 1 , 2 ]. Unfortunately, LA does not solely affect individuals physically but has a multifaceted impact on quality of life, including significant social, psychological, cultural, and economic burdens placed on the patient, family, and caregivers [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006–2019

Essien

Linassi

Larocque³

et al. 2021

PLoS ONE

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Background There is conflicting evidence whether limb amputation (LA) disproportionately affects indigenous populations. To better understand this disparity, we compared the LA incidence rate between First Nations persons registered under the Indian Act of Canada (RI) and the general population (GP) in Saskatchewan. Methods We used Saskatchewan’s retrospective administrative data containing hospital discharge LA cases, demographic characteristics (age and sex), and residents population reported in the database stratified by RI and GP from 2006–2019. The LA cases for each stratified group were first disaggregated into three broad categories: overall LA (all reported LA), primary LA (first reported LA), and subsequent LA (revision or contralateral LA), with each category further split into the level of amputation defined as major amputation (through/above the ankle/wrist joint) and minor amputation (below the ankle/wrist joint). LA rates were calculated using LA cases as the numerator and resident population as the denominator. Joinpoint and negative binomial regressions were performed to explore the trends further. Results Overall, there were 1347 RI and 4520 GP LA cases reported in Saskatchewan from 2006–2019. Primary LA made up approximately 64.5% (869) of RI and 74.5% (3369) of GP cases, while subsequent LA constituted 35.5% (478) of RI and 25.5% (1151) of GP cases. The average age-adjusted LA rate was 153.9 ± 17.3 per 100,000 in the RI cohort and 31.1 ± 2.3 per 100,000 in the GP cohort. Overall and primary LA rates for the GP Group declined 0.7% and 1.0%, while subsequent LA increased 0.1%. An increased LA rate for all categories (overall 4.9%, primary 5.1%, and subsequent 4.6%) was identified in the RI group. Overall, minor and major LA increased by 6.2% and 3.3%, respectively, in the RI group compared to a 0.8% rise in minor LA and a 6.3% decline in major LA in the GP group. RI females and males were 1.98–1.66 times higher risk of LA than their GP counterparts likewise, RI aged 0–49 years and 50+ years were 2.04–5.33 times higher risk of LA than their GP cohort. Diabetes mellitus (DM) was the most prevalent amputation predisposing factor in both groups with 81.5% of RI and 54.1% of GP diagnosed with DM. Also, the highest proportion of LA was found in the lowest income quintile for both groups (68.7% for RI and 45.3% for GP). Conclusion Saskatchewan’s indigenous individuals, specifically First Nations persons registered under the Indian Act of Canada, experience LA at a higher rate than the general population. This disparity exists for all variables examined, including overall, primary, and subsequent LA rates, level of amputation, sex, and age. Amplification of the disparities will continue if the rates of change maintain their current trajectories. These results underscore the need for a better understanding of underlying causes to develop a targeted intervention in these groups.

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Autoamputation of diabetic toe with dry gangrene: a myth or a fact?

Cited by 24 publications

References 41 publications

Clinical Classification of the Diabetic Foot Syndrome Adapted to ICD-10 as a Solution to the Problem of Diagnostics, Statistics and Standardisation

Clinical Classification of the Diabetic Foot Syndrome Adapted to ICD-10 as a Solution to the Problem of Diagnostics, Statistics and Standardisation

Pathology of Gangrene

Incidence and trends of limb amputation in first nations and general population in Saskatchewan, 2006–2019

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