Mortality and Diabetes Mellitus in Amputations of the Lower Limbs for Gas Gangrene: A Case Report

Godoy, José María Pereira de; Ribeiro, Janalice Vasconcelos; Caracanhas, Lívia Andrioli

doi:10.1177/1534734608324123

Cited by 8 publications

(4 citation statements)

References 5 publications

(6 reference statements)

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“…Another study reported a 44% mortality rate in the 1 st year, 50% in the 2 nd year, and 72% in 6 years. [ 7 , 8 ] Therefore, diabetes is a disease with a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Diabetes as an isolated cause of minor lower limb amputations

Godoy¹

2022

Sisli Etfal

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Objectives: Amputation is a devastating but preventable complication of diabetes and peripheral arterial disease. The aim of the present study was to investigate whether diabetes mellitus is an important isolated cause of toe amputation. Methods: A cross-sectional study was conducted involving the records of 108 patients with minor lower limb amputations and 80 with major lower limb amputations. Association between diabetes/chronic arterial insufficiency and level of amputation was tested. Statistical analysis was performed using Fisher’s exact test. Results: The prevalence of diabetes was 87.5% among patients submitted to minor amputations and 52.5% among those submitted to major amputations with or without chronic arterial disease. This difference was statistically significant (p<0.0001, Fisher’s exact test). A total of 44.44% of the patients submitted to minor amputations had diabetes alone (no chronic arterial insufficiency), whereas only 14.81% of the patients submitted to major amputations did not have chronic arterial insufficiency. Thus, diabetes was significantly associated with minor lower limb amputations (p<0.0004, Fisher’s exact test). Conclusion: Based on the present findings, patients with diabetes are at greater risk of toe amputation compared to those with chronic arterial disease.

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“…Another study reported a 44% mortality rate in the 1 st year, 50% in the 2 nd year, and 72% in 6 years. [ 7 , 8 ] Therefore, diabetes is a disease with a high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Diabetes as an isolated cause of minor lower limb amputations

Godoy¹

2022

Sisli Etfal

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“…Our case is unique in two aspects. First, as we all know, the responsible organism C. perfringens is mostly associated with development of traumatic gas gangrene but also can be associated with the nontraumatic spontaneous gas gangrene in patients with immunocompromised condition including malignancies and diabetes mellitus [ 2 , 32 ]. Impaired evacuation and motility of the stomach (and the small intestine) has been described in diabetics with long lasting unsatisfactory diabetes compensation, microangiopathic complications, and diabetic autonomous neuropathy [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Gas Gangrene in Orthopaedic Patients

Ying

Zhang

Yan

et al. 2013

Case Reports in Orthopedics

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Clostridial myonecrosis is most often seen in settings of trauma, surgery, malignancy, and other underlying immunocompromised conditions. Since 1953 cases of gas gangrene have been reported in orthopaedic patients including open fractures, closed fractures, and orthopaedic surgeries. We present a case of 55-year-old obese woman who developed rapidly progressive gas gangrene in her right leg accompanied by tibial plateau fracture without skin lacerations. She was diagnosed with clostridial myonecrosis and above-the-knee amputation was carried out. This patient made full recovery within three weeks of the initial episode. We identified a total of 50 cases of gas gangrene in orthopaedic patients. Several factors, if available, were analyzed for each case: age, cause of injury, fracture location, pathogen, and outcome. Based on our case report and the literature review, emergency clinicians should be aware of this severe and potentially fatal infectious disease and should not delay treatment or prompt orthopedic surgery consultation.

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“…The wound infection rates following major lower limb amputation vary between 13% and 40%. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common cause of post-amputation infections (10,11). The morbidity and mortality rates usually in- crease as a result of MRSA infection in vascular patients (12)(13)(14).…”

Section: Infection Of the Stumpmentioning

confidence: 99%