Pathophysiology of Diabetic Ulcers

Diabetes makes disorders / complications through damage to blood vessels throughout the body, called diabetic angiopathy. The disease runs a chronic and is two large vascular disorders (macrovascular) called macroangiopathy, and the small blood vessels (microvascular) called microangiopathy. If the affected blood vessels in the brain arise stroke, blindness occurs when the eye, the heart of coronary heart disease which can lead to heart attack / myocardial infarction, the kidneys become chronic kidney disease to end stage renal failure and should be dialysis or transplantation. When on foot injuries occur that are difficult to heal up into decay (gangrene). Moreover, if the affected nerve arises diabetic neuropathy, so there are parts that do not taste anything / numbness, though needles / spikes or exposed to hot objects.

Abnormalities of the lower limbs due to diabetes caused by vascular disorders, neurological disorders, and infection. In vascular disorders, feet can hurt, if tangible feel cold, if there are wounds are difficult to heal because blood flow to the parts have been reduced. Examination difficult palpable pulse in the legs, the skin appears pale or bluish, then eventually can become gangrenous / tissue decay, then infected and bacteria thrives, it will be dangerous for patients because the infection can spread throughout the body (sepsis). In the event of a nervous breakdown, called diabetic neuropathy may arise taste disorders (sensory) numbness, lack of taste to numbness. In addition, motor disturbances, muscle weakness arises, decreases muscle, muscle cramps, tiredness. Legs that do not taste would be dangerous because when stepping on sharp objects will not be felt when it had been incurred injuries, coupled with the ease of infection. If it's gangrene, legs should be cut in the upper part of the rot.

Diabetic gangrene is a long-term impact of arteriosclerosis and small thrombus embolism. Diabetic angiopathy almost always also lead to peripheral neuropathy. Diabetic neuropathy is a disruption of motor, sensory and autonomic, each of which plays a role in the occurrence of foot injuries. Paralysis of the leg muscles leads to changes in the balance of the foot joints, changes in gait, and will lead to new pressure points on the soles of the feet, causing a callus on the spot.

Sensory disturbance causes local numbness and loss of protection against trauma, so people were injured unnoticed. As a result, the callus can turn into ulcers which when coupled with the infection developed into cellulitis and ended up with gangrene.

Autonomic nerve disorder that results in loss of skin secretions dry skin and easy bruising are difficult to heal. And wound infections are difficult to heal and prone to necrosis resulting from three factors. The first factor is angiopathy arterioles causing poor tissue perfusion feet so that the mechanism of inflammation so ineffective. The second factor is the blood sugar environment fertile for the development of pathogenic bacteria. The third factor is the opening of the artery-vein bypass in subcutaneous, nutrient flow will bypass the site of infection in the skin.

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