A: Diabetes is associated with impaired response to injury. Patients with diabetes frequently do not mount a significant inflammatory response to injury. Further, the nerve damage common in diabetic patients prevents them from noticing pain from minor injuries to the foot that allow bacteria a portal of entry. The combination of decreased immune response and decreased sensation in a diabetic patients means a minor cut can lead to a major infection, potentially requiring amputation. This patient presented with mild cellulitis after a toe amputation (panel a). Despite only having minimal erythema, the patient had gas gangrene (panel b—closed arrows indicate subcutaneous gas). He ultimately required extensive drainage and debridement (panel c). Diabetic wound care and foot care is incredibly important to prevent these outcomes.
A: Diabetes is associated with impaired response to injury. Patients with diabetes frequently do not mount a significant inflammatory response to injury. Further, the nerve damage common in diabetic patients prevents them from noticing pain from minor injuries to the foot that allow bacteria a portal of entry. The combination of decreased immune response and decreased sensation in a diabetic patients means a minor cut can lead to a major infection, potentially requiring amputation. This patient presented with mild cellulitis after a toe amputation (panel a). Despite only having minimal erythema, the patient had gas gangrene (panel b—closed arrows indicate subcutaneous gas). He ultimately required extensive drainage and debridement (panel c). Diabetic wound care and foot care is incredibly important to prevent these outcomes.
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