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Diabetic gangrene: medical and surgical causes and consequences.

Diabetic gangrene is the chronic complication which involves many medical, economic and social problems. In this study we have analyzed the medical and surgical causes and consequences of diabetic gangrene on three groups of patients: 120 patients (96 males and 24 females; aged (X +/- SD) 57 +/- 14 years hospitalised in the Clinic of Diabetes, Nutrition and Metabolic Diseases of the "N. Paulescu" Institute, 72 patients (59 males and 13 females; mean age 60 +/- 10 years) hospitalised in the Surgical Clinic of Cantacuzino Hospital; 29 patients (23 males and 6 females; mean age 58 +/- 11 years) hospitalised in the Cardiovascular Department of Fundeni Hospital. The analyses of data obtained showed: in 77% of cases the initial lesions might have been avoided by an appropriate education programme of the patients; in 66% of cases the progression of lesion from medical to surgical stage was caused by tardily coming of patient to physician; average duration of hospitalization was 27 days in the Clinic of Diabetes, Nutrition and Metabolic Diseases, 33 days in the Clinic of Surgery of "Cantacuzino" Hospital and 25 days in Cardiovascular Department of Fundeni Hospital; the surgical mortality was 8%; 47% operated patients were cured and 53% were incompletely cured and required more out patient care; 35% were thigh amputations, that shows the high invalidity potential of diabetic gangrene; the cost of medical and/or surgical care of diabetic gangrene is higher than the cost of hospitalisation for other patients; the diabetic gangrene predominantly neuropathic was better cured and the arteriopathic component breaks the medical curing and impose high amputations; diabetic gangrene is more frequent with older people, but with young people it is a cause of early retiring and psycho-social concern.