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By Lahle Wolfe


Podiatry Today, "Gangrene" and "Infections," excerpts have been edited and revised for content

Related information

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Medicare & Mediciad Requirements for Diabetics Seeking HBO Therapy

In March, 2003, Medicare began reimbursing for hyperbaric oxygen (HBO) treatment as an adjunctive therapy for diabetic foot ulcers

Patients must meet all of three criteria in order to be eligible for hyperbaric treatment:

  1. must have type 1 or type 2 diabetes and a lower extremity wound that is due to diabetes;
  2. must have a wound classified as Wagner grade III or higher; and
  3. the patient has failed an adequate course of standard wound therapy.

It is also required that the patient show no measurable signs of healing with standard therapy for at least 30 days prior to initiation of HBO.

Source: Podiatry Today

Maggot Therapy Speeds Healing of Diabetic Foot Ulcers

5 questions-and answers-about maggot debridement therapy

Maggot Therapy for Treating Diabetic Foot Ulcers Unresponsive to Conventional Therapy

Maggot Therapy Speeds Healing of Diabetic Foot Ulcers

Diabetes Watch: Treatment Options For Diabetic Foot Infections

Are Tissue Replacements Cost Effective?
Diabetic wounds can become chronic and non-healing for multiple reasons. Each product mentioned below has different indications. Tissue replacements are cost effective because they reduce the healing time of chronic wounds.

Closer Look At Diabetic Foot Infections
With a strong emphasis on the recent guidelines of the Infectious Diseases Society of America (IDSA), these authors discuss how to differentiate among mild, moderate and severe infections, and discuss appropriate antibiotic therapy to manage these infected wounds.

Guide To New Classifications For Diabetic Foot Infections
The Infectious Diseases Society of America and the International Working Group for the Diabetic Foot have provided new classification systems for diabetic foot infections. The panelists summarize these classifications and offer their thoughts on the clinical diagnosis of infection

Treatment Options For Diabetic Foot Infections
Once the dermal barrier has been broken, there is a resulting open portal for infection of the deep tissue.3 The diabetic foot is a fertile ground for a number of infectious complications.


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Diabetes Complications

Infections, Gangrene & Diabetes
Risks, Causes, Treatment & Prevention

Mini Site Index
What is an infection?
Diabetes and Infections: Risk Factors and Prevention
History of Infection Treatments
What is gangrene?
Types of Gangrene
Wet Gangrene
Dry Gangrene  

What is an infection?

The medical definition of infection,  is defined as the invasion of the body by pathogenic microorganisms and their multiplication which can lead to tissue damage and disease.  This simply means that an organism, (including bacteria, parasites, fungi, and  viruses) enter the body and begin to grow out of control.  The body responds with inflammation (swelling) and by producing pus (the white, sticky, secretion commonly seen with many types of infections).

Infections can lead to chronic wounds, gangrene, loss of an infected limb, and even death.  Some bacteria and organisms are harmless to people unless the actually penetrate the body.  As an example, the staphylococcus species are present on skin and harmless, however, when they invade in a normally sterile space, such as in the capsule of a joint or the peritoneum, they will multiply without resistance, and infection spreads rapidly.

The specialty of medicine that deals with the treatment of infections is "infectious disease."  

Diabetes and Infections: Risk Factors and Prevention

For people with diabetes, the risk of infection elevates the higher their HbA1c.  This is largely due because chronic hyperglycemia leads to neuropathy, which decreases circulation and diminishes a person's sense of pain.  All these things can contribute to even a small cut or blister on the foot becoming infected.  Special attention should be given to the feet of those with diabetes each day.  Visual inspection, massage, and lotions should be part of daily diabetes self-care.

People with diabetes may also have dry, itchy skin.  Scratching the skin can cause tiny abrasions, or even open sores that are vulnerable to infection.  

Studies show that tight blood glucose control reduces risk of all diabetes complications including infections.  Hyperglycemia also slows down how fast a person may recover from infection.  Patients who require amputation have a more favorable outcome post surgery (i.e., those receiving only partial foot amputation may not require further amputation) than do those with a high HbA1c.

It is important to keep your blood glucose under control, drink plenty of fluids for healthier skin, and at the first sign of any cut or wound not healing, especially on the feet, see your doctor immediately.

History of Infection Treatments

In the years before antibiotics, fly maggots were commonly used to treat chronic wounds or ulcers to prevent or stop necrotic spread (dying tissue). Some species of maggots consume only dead flesh, leaving nearby living tissue unaffected. Their use largely died out after the introduction of antibiotics and enzyme treatments for wounds but in recent years, however, maggot therapy has regained some credibility and is sometimes employed to great effect in cases of chronic tissue necrosis (see sidebar for more information on maggot therapy).  

What is gangrene?

Gangrene is necrosis (tissue death) and subsequent decay of body tissues caused by infection or thrombosis or lack of blood flow. It is usually the result of critically insufficient blood supply sometimes caused by injury and subsequent contamination with bacteria. This condition is most common in the extremities. The best of all possible treatments is revascularization (restoration) of the affected organ, which can reverse some of the effects of necrosis and allow healing. Depending on the extent of tissue loss and location, treatment other than revascularization runs the gamut from allowing digits to auto-amputate (fall off), debridement and local care, to amputation, the removal of infected necrotic tissues.  

Types of Gangrene

Gangrene caused by a serious bacterial infection is called wet gangrene.

Gangrene caused by lack of circulation in an injured or diseased area is called dry gangrene.

One specific example of gangrene is so called diabetic foot that can be seen in long-standing complicated diabetes. It is caused by a combination of arterial ischemia, injury, and poor healing that is commonly seen in patients with diabetes.

The most common surgical treatment for irreversible gangrene is immediate amputation, as the infection grows 2 to 3 cm per hour.  For more information on surgical procedures, studies, and patient outcome relating to amputation, please see our section on "Amputation."

Wet Gangrene

Wet gangrene occurs when an injury, such as a gunshot wound or laceration, leads to a bacterial infection, which produces pus.  If the pus does not drain well, the blood supply to the area is blocked, and with it, the oxygen. With its oxygen supply cut off, the tissue dies.

Treatment of the underlying infection is necessary, as is removal of the dead tissue. Without treatment, the infection can spread further and destroy increasing amounts of tissue.  Eventually, sepsis (the presence of pus-forming bacteria or their toxins in the blood or tissues) and death can result.  

Dry Gangrene

If the blood flow is interrupted for a reason other than severe bacterial infection, the result is a dry gangrene. Persons with impaired peripheral blood flow, such as diabetics, are at greater risk for dry gangrene.  Perhaps you have seen a movie portrayal of some sort of accident where the "hero" bravely ties a tight turniquette to stop blood flow.  But when blood flow is stopped, for any reason, gangrene can result.  Another example of dry gangrene is when gangrene results from frost bite where tissues freeze and there is no longer blood circulating.

The early signs of dry gangrene are a dull ache and sensation of coldness in the area, along with pallor (paleness) of the flesh. If caught early, the process can sometimes be reversed by vascular surgery. However, if necrosis (tissue death) sets in, the affected tissue must be removed just as with wet gangrene.


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Page Updated 03/24//2006