1.

Education
Emphasizing efforts to prevent and detect early in patients with normal legs or
neuropathic / neuroiskemic disorders but there are no injuries. High-risk patients
must be identified during routine foot examinations in DM patients. Education
should emphasize the careful selection of footwear, daily foot examinations to
detect signs of improper footwear or minor trauma, maintain hygiene and
moisture in the feet, avoid high-risk behavior, and consult health personnel if
there are abnormalities.
Treatment for Gangrene
A. Dry
 Rest in bed
 Control of blood sugar with diet, insulin or antidiabetic drugs
 Measures to prevent the spread of gangrene amputation, but with a very clear
indication
 Improve the circulation in order to overcome angiopathy with anti-platelet drugs
aggregation (aspirin, diprydamol, or pentoxyvilin)
A. Wet
 Rest in bed
 Control of blood sugar with diet, insulin or antidiabetic drugs
 Debridement
 Compress with warm water, not hot or cold water
 Give "topical antibiotic"
 Give an appropriate antibiotic or culture with broad-spectrum antibiotic
 To provide neuropathy pyridoxine (vitamin B6) or other neurotrophic
 Improve the circulation in order to overcome angiopathy with anti-platelet drugs
aggregation (aspirin, diprydamol, or pentoxyvilin)
B. Surgery
 Amputation soon

1
  Debridement and drainage, after calm then action can be taken was amputations
or skin / arterial graft

There are several choices in debridement actions, namely

o Mechanical debridement, enzymatic, autolytic, biological, surgical debridement.
a) Mechanical debridement is carried out using physiological fluid wound
irrigation, ultrasonic laser, etc., in order to clean the necrotic tissue.
b) Enzymatic debridement is carried out by topically administering exogenous
enzymes on the surface of the lesion. The enzyme will destroy the residual
protein residue. For example, collagenizing provides collagen and elastin. Some
types of debridement that are often used are papine, DNAse and fibrinolisin.
c) Autolytic debridement occurs naturally when a person is injured. This process
involves endogenous macrophages and proteolytic enzymes that naturally lyse
necrotic tissue. Synthetically, hydrogel and hydrocolloid preparations can create
optimal environmental conditions for the body's phagocytes and act as agents
that lyse necrotic tissue and stimulate the granulation process. Sterilized maggots
(Lucilla serricata) are often used for biological debridement. Maggots produce
enzymes that can destroy necrotic tissue.
d) Surgical debridement is the most rapid and efficient type of debridement. The
aim of surgical debridement is to:
1. Evacuate contaminated bacteria,
2. Lifting necrotic tissue so that it can speed healing,
3. Eliminating callus tissue,
4. Reduce the risk of local infection.