How to cite:
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus.
(2022). Profile Of Pedis Gas Gangrene Patients With Type II Diabetes
Mellitus At Bhayangkara Hospital Kediri Period January 2021 - March
2022. Journal of Eduvest. Vol 2 (9): Page 1868-1880
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Eduvest – Journal of Universal Studies
Volume 2 Number 9, September, 2022
p- ISSN 2775-3735 - e-ISSN 2775-3727
PROFILE OF PEDIS GANGRENE PATIENTS WITH TYPE II
DIABETES MELLITUS AT BHAYANGKARA HOSPITAL
KEDIRI PERIOD JANUARY
2021 - MARCH 2022
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Muhammadiyah University, Malang, Indonesia
123
Email: [email protected]
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ABSTRACT
Gas gangrene is a disease that is identical to the incidence of
type 2 diabetes mellitus with the characteristics of muscle
necrosis / myonecrosis and is a very deadly infection of the
inner soft tissues, often caused by gram-positive bacteria such
as Staphylococcus aureus, Clostridium perifingens. Diabetes
mellitus is a collection of symptoms caused by disturbances in
the balance between carbohydrates, fats and proteins caused
by absolute or relative insulin deficiency, causing
hyperglycemia and glucosuria. to describe the profile of
patients with gas gangrene pedis caused by type II diabetes
mellitus obtained from the results of secondary data research
at Bhayangkara Hospital Kediri Period January 2021 -
March 2022. This study is an observational study (Non
Experimental Design) using a cohort retrospective design
method. The sample in this study were patients with Gas
Gangrene Pedis who were obtained from the patient's medical
records in the period January 2021 - March 2022 at
Bhayangkara Hospital Kediri with Type II Diabetes Mellitus.
Results: Based on the results of the Association Test between
Wagner Grade and Gas Therapy, gangrene pedis has a p
value of 0.199. The Wagner Grade variable with gas
gangrene pedis therapy had an insignificant relationship with
debridement measures n = 8 and the most common bacterium
was Pseudomonas aeruginosa with n = 4. Patients with gas
gangrene pedis who had a history of not routinely controlling
because of their DM treatment, there was a high probability
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Profile Of Pedis Gas Gangrene Patients With Type II Diabetes Mellitus At
Bhayangkara Hospital Kediri Period January 2021 - March
1869
of progressive progression. worsening of his condition due to
metabolic neuropathy and the effect of different treatment
outcomes for each patient
KEYWORDS
Gas gangrene, Type II Diabetes Mellitus, Debridement,
Pseudomonas aeruginosa
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Attribution-ShareAlike 4.0 International
INTRODUCTION
Gas gangrene is a disease that is identical to the incidence of type 2
diabetes mellitus with the characteristics of muscle necrosis / myonecrosis and is a
very lethal infection of the inner soft tissues, often caused by gram-positive
bacteria such as Staphylococcus aureus, Clostridium perifingens (Buboltz &
Murphy-Lavoie, 2019). Diabetes mellitus is a collection of symptoms caused by a
disturbance in the balance between carbohydrates, fats and proteins caused by
absolute or relative insulin deficiency, causing hyperglycemia and glucosuria
(Erin, 2015). Type II diabetes mellitus occurs due to insulin resistance due to
impaired glucose uptake and decreased production of pancreatic beta cells
resulting in reduced insulin secretion and activity. Type II DM patients can be at
risk for chronic complications such as CHD & stroke, kidney failure, retinopathy
and diabetic gangrene (Erin, 2015). Avascular Necrosis / Osteonecrosis is a
degenerative bone condition characterized by the death of bone cellular
components due to impaired subchondral blood supply (Cruz et al., 2021). Often
affects the epiphyses of long bones in joints that bear too much weight, or in
bones where the surrounding tissue has an infection, one of which is caused by the
bacterium Staphylococcus aureus (Fauzan, Saputra, & Mahmuda, 2019). Multiple
Avascular Necrosis (MAVN) is an event of osteonecrosis that develops as a result
of vascular disorders in the bone, causing necrosis of bone marrow cells,
osteocytes and trabecular cells to cause bone collapse in the necrotic segment
(Alalawi, Alnour, & Kosi, 2017). Incidence in the United States regarding the
incidence of gangrene pedis is only about 1000 cases per year from the statistical
results in December 2021, in less developed countries such as India with reduced
access to health services and antibiotics, the incidence is higher and has a
mortality rate of more than 67% of 8000 residents in India & Vietnam in 2019
(Buboltz & Murphy-Lavoie, 2019). The Indonesian Ministry of Health in 2012
stated that diabetes mellitus was included in the top ten non-communicable
diseases with the highest number. In 2017, diabetes mellitus was the highest
ranked non-communicable disease in the city of Semarang, with 21,159 cases
which showed an increase in cases from the previous year (Rosa, Udiyono,
Kusariana, & Saraswati, 2019). Epidemiological studies conducted by (Sukmana,
Sianturi, Sholichin, & Aminuddin, 2020) show that in Indonesia there are more
than one million cases of amputations each year due to diabetic gangrene. The
proportion of people with diabetic gangrene in Indonesia is around 15% with an
amputation rate of 30% (Rosa et al., 2019). Another study stated that the
incidence of peripheral neuropathy due to multiple osteonecrosis in gangrene
pedis patients obtained diabetic ulcers due to suffering from type II diabetes
mellitus > 5 years with a risk level 2 times higher than < 5 years suffering from
Eduvest – Journal of Universal Studies
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type II diabetes mellitus (Sukmana et al., 2020). In the United States 10% of
patients with multiple osteonecrosis occur in the age group 30-65 years, men tend
to be more affected than women (Fatimah, 2015). The other 90% of cases are
more often suffered by patients aged over 65 years with the term Keinbock
disease / Crescent Osteonecrosis with the most patients being women than men,
namely 3,125 residents of the United States. Indonesia, which is a developing
country, (Fitri, 2021) type II diabetes mellitus, which becomes gangrene pedis, is
still a significant health problem because the community's prevalence and
mortality rate is still high and the lifestyle is still bad (Fauzan et al., 2019). One of
the potential causes for the occurrence of Multiple Avascular Necrosis in
Gangrene Pedis patients is a microorganism which is a facultative anaerobic
bacterium, namely Staphylococcus aureus, where bacteria enter through soft
tissue causing diabetic gangrene injuries (Alalawi et al., 2017), to cause peripheral
neuropathy due to damage from the kidneys. blood supply to bone cells which
results in the death of many bone cells in several parts or compartments and is a
pathological process of bacterial infection from diabetic gangrene pedi (Sinaga,
Nufus, & Setiyohadi, 2014).
Therapy in patients with gangrene pedis is very important and is carried
out quickly and progressively with antibiotics, wound debridement in consultation
with a surgical specialist, intravenous fluid resuscitation, ICU monitoring, and
adjuvant hyperbaric oxygen therapy (Buboltz & Murphy-Lavoie, 2019). In
addition, local astringents such as boric acid, tannic acid and antibacterial agents
such as neobakrine ointment, can be given as a treatment for gangrene pedis, this
can be given in combination with several other irritant drugs such as tincture of
iodine, mercury bin-iodide with limited use and under the supervision of a
surgical specialist. (Sukmana et al., 2020) The drug to eradicate bacterial infection
in gangrene pedis is antibiotics. Antibiotics are defined as the result of production
in the form of chemicals, where these materials can interfere with other
microorganisms such as bacteria and fungi (Kaye, Petty, Shorr, & Zilberberg,
2019). Multiple osteonecrosis can be treated with prophylaxis or reconstructive
surgery in other words, this therapy is to slow the progression of osteonecrosis by
endoprosthetic replacement of the affected bone & soft tissue (Rahayu, Masfiyah,
Puspitasari, & Sari, 2016). The most frequently used prophylactic surgery is core
decompression of the femoral head, to prevent venous congestion and to stimulate
repair (Nabiu, Anandani, & Hardiansyah, 2021). Decompression can also be
performed at the malleoli pedis to improve mechanical support and promote
healing of avascular necrosis caused by the bacterium Staphylococcus aureus in
gangrene pedis, confirmed by arthroscopic examination of the joint showing
varying degrees of chondral folds and features of joint degeneration with joint
collapse due to gangrene pedis (Rina, Setyawan, Nugroho, Hadisaputro, &
Pemayun, 2016). Administration of pencillin and clindamycin includes
prophylactic therapy in patients with gangrene pedis (Buboltz & Murphy-Lavoie,
2019) with avascular necrosis because of its broad spectrum for Streptococcal
group bacteria followed by continued physiotherapy thereafter (Matthews, Davis,
Fish, & Stitson, 2021).
Ischemic foot is characterized by reduced blood supply. This relates to the
symptoms of patients with gangrene pedis. Often found, patients complain of leg
pain when standing, walking or when carrying out other physical activities. Pain
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Profile Of Pedis Gas Gangrene Patients With Type II Diabetes Mellitus At
Bhayangkara Hospital Kediri Period January 2021 - March
1871
can also occur in the arcus pedis at rest or at night (Rosa et al., 2019). On
examination, the skin discoloration becomes pale, thin and shiny or bluish in color
(Sinaga et al., 2014). The feet are cold and the posterior tibial or popliteal pulse is
difficult to palpate and ulcers are found that are difficult to heal and become
gangrene (Rosa et al., 2019). When examining gangrene patients with peripheral
neuropathy due to avascular necrosis, it was found that there were deformities and
sclerotic changes around the patient's pedis, especially around the malleolus bone
(Sukmana et al., 2020). Patients experience pain, especially when they want to
walk, and pain is felt up to the patient's hip, this is found to be due to a nectrotic
process in the bone in the femur on the side that has gangrene pedis, often called
arthritic pain (Sukmana et al., 2020).
RESEARCH METHOD
This study uses quantitative methods with data obtained descriptively, the
statistical test used is the Chi-square correlation statistical test from Pearson with
a qualitative categorical data scale to determine a statistically significant
relationship between independent and dependent variables with a significance
degree of 5%. or = 0.05 through the Statistical Package for the Social Sciences
(SPSS) program.
RESULTS AND DISCUSSION
A. Data Analysis Results
1. Descriptive statistics
Table 1
Descriptive statistics
n
%
mean
stdev
Wagner Grade
Grade I
1
8.33
Grade II
4
33.33
Grade III
1
8.33
Grade IV
3
25.00
Grade V
3
25.00
Gender
Man
7
58.33
Woman
5
41.67
bacterial culture
Pseudomonas aeruginosa
8
66.67
Staphylococcus aureus
3
25.00
Streptococcus pyogenes
1
8.33
long time DM II
Less than 1 Year
7
58.33
1 year and up
5
41.67
Osteomyelitis
Negative
8
66.67
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Positive
4
33.33
Avascular necrosis
Negative
7
58.33
Positive
5
41.67
Charcott
Negative
9
75.00
Positive
3
25.00
DM therapy
Glibenclamide
1
8.33
Glimepiride
1
8.33
Long & Rapid Acting
1
8.33
Metformin
4
33.33
Rapid Acting Insulin
5
41.67
Diabetic Foot Therapy
Amputation
4
33.33
Debridement
8
66.67
Age
12
42.08
17.79
Hb
12
10.50
1.93
Leukocytes
12
204916.67
86379.14
Neutrophils
5
10300.00
1717.56
LED
5
21.40
1.67
GDA
12
295.42
42.61
HbA1c
12
8.33
0.49
2. Wagner Grade Comparison
The descriptive results of the comparison between Wagner Grades are
presented in the following table.
Table 2
Wagner Grade Comparative Test Results
N
mean
Std. Deviation
Hb
Grade I
1
10.00
.
Grade II
4
10.50
1.29
Grade III
1
10.00
.
Grade IV
3
11.67
2.08
Grade V
3
9.67
3.21
Leukocytes
Grade I
1
288000.00
.
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Profile Of Pedis Gas Gangrene Patients With Type II Diabetes Mellitus At
Bhayangkara Hospital Kediri Period January 2021 - March
1873
Grade II
4
176250.00
88635.49
Grade III
1
110000.00
.
Grade IV
3
256666.67
50083.26
Grade V
3
195333.33
113975.14
Neutrophils
Grade I
0
.
.
Grade II
2
11000.00
1414.21
Grade III
1
9500.00
.
Grade IV
1
12000.00
.
Grade V
1
8000.00
.
LED
Grade I
0
.
.
Grade II
2
20.50
0.71
Grade III
1
20.00
.
Grade IV
1
24.00
.
Grade V
1
22.00
.
GDA
Grade I
1
295.00
.
Grade II
4
270.00
44.16
Grade III
1
280.00
.
Grade IV
3
343.33
32.15
Grade V
3
286.67
32.53
HbA1c
Grade I
1
8.00
.
Grade II
4
8.25
0.50
Grade III
1
8.00
.
Grade IV
3
8.33
0.58
Grade V
3
8.67
0.58
Data source: Appendix 3
3. Wagner Grade Cross Tabulation
Wagner grade cross ablation results can be seen in Table 5.3
Table 3
Cross-tabulation results between Wagner Grade and Gender
Wagner Grade
Gender
Total
p
Man
Woman
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Grade I
0
1
1
0.489
Grade II
3
1
4
Grade III
0
1
1
Grade IV
2
1
3
Grade V
2
1
3
7
5
12
Based on the results of the Association Test between Wagner Grade and
gender, it has a p value of 0.489 ,. Because the significance value (p) is greater
than =5%, the hypothesis H0 is accepted. This means that the Wagner Grade
variable caused by gender has an insignificant relationship.
Table 4
Cross Tabulation Results between Wagner Grade and Bacterial
Culture
Wagner
Grade
bacterial culture
Total
p
Pseudomonas
aeruginosa
Staphylococcus
aureus
Streptococcus
pyogenes
Grade I
1
0
0
1
0.805
Grade II
3
1
0
4
Grade III
1
0
0
1
Grade IV
1
1
1
3
Grade V
2
1
0
3
8
3
1
12
Based on the results of the Association Test between Wagner Grade and
Bacterial Culture, it has a p value of 0.805 ,. Because the significance value (p) is
greater than =5%, the hypothesis H0 is accepted. This means that the Wagner
Grade variable caused by Bacterial Culture has an insignificant relationship.
Table 5
Cross-tabulation results between Wagner Grade and DM . duration
Wagner Grade
long time DM II
Total
p
Less than 1 Year
1 year and up
Grade I
1
0
1
0.187
Grade II
3
1
4
Grade III
1
0
1
Grade IV
2
1
3
Grade V
0
3
3
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Profile Of Pedis Gas Gangrene Patients With Type II Diabetes Mellitus At
Bhayangkara Hospital Kediri Period January 2021 - March
1875
7
5
12
Based on the results of the Association Test between Wagner Grade and
DM duration, it has a p value of 0.187 ,. Because the significance value (p) is
greater than =5%, the hypothesis H0 is accepted. This means that the Wagner
Grade variable caused by the length of DM has an insignificant relationship.
Table 6
Cross-tabulation results between Wagner Grade and Complications of
Osteomyelitis
Wagner Grade
Osteomyelitis
Total
p
Negative
Positive
Grade I
1
0
1
0.622
Grade II
3
1
4
Grade III
1
0
1
Grade IV
2
1
3
Grade V
1
2
3
8
4
12
Based on the results of the Association Test between Wagner Grade and
Complications of Osteomyelitis, it has a p value of 0.622 ,. Because the
significance value (p) is greater than =5%, the hypothesis H0 is accepted. This
means that the Wagner Grade variable caused by Osteomyelitis Complications has
an insignificant relationship.
Table 7
Cross-tabulation results between Wagner Grade and Complications of
Avascular necrosis
Wagner Grade
Avascular necrosis
Total
p
Negative
Positive
Grade I
1
0
1
0.055
Grade II
4
0
4
Grade III
1
0
1
Grade IV
1
2
3
Grade V
0
3
3
7
5
12
Based on the results of the Association Test between Wagner Grade and
Complications of Avascular necrosis, it has a p value of 0.055 ,. Because the
Eduvest – Journal of Universal Studies
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significance value (p) is greater than =5%, the hypothesis H0 is accepted. This
means that the Wagner Grade variable caused by Complications of Avascular
necrosis has an insignificant relationship.
Table 8
Cross-tabulation results between Wagner Grade and Charcott
Wagner Grade
Charcott
Total
p
Negative
Positive
Grade I
1
0
1
0.299
Grade II
4
0
4
Grade III
0
1
1
Grade IV
2
1
3
Grade V
2
1
3
9
3
12
Based on the results of the Association Test between Wagner Grade and
Charcott, it has a p value of 0.299 ,. Because the significance value (p) is greater
than =5%, the hypothesis H0 is accepted. This means that the Wagner Grade
variable is caused by Charcott having an insignificant relationship.
Table 9
Cross-tabulation results between Wagner Grade and DM . therapy
Wagner
Grade
DM therapy
Total
p
Gliben
clamid
e
Gli
mep
iride
Long &
Rapid
Acting
Metfor
min
Rapid Acting
Insulin
Grade I
0
0
0
1
0
1
0.525
Grade II
0
0
0
2
2
4
Grade III
0
0
0
0
1
1
Grade IV
0
0
0
1
2
3
Grade V
1
1
1
0
0
3
1
1
1
4
5
12
Based on the results of the Association Test between Wagner Grade and
DM therapy, it has a p value of 0.525 ,. Because the significance value (p) is
greater than =5%, the hypothesis H0 is accepted. This means that the Wagner
Grade variable with DM therapy has an insignificant relationship.
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Profile Of Pedis Gas Gangrene Patients With Type II Diabetes Mellitus At
Bhayangkara Hospital Kediri Period January 2021 - March
1877
Table 10
Cross-tabulation results between Wagner Grade and Pedis Gangrene
Therapy
Wagner Grade
Diabetic Foot Therapy
Total
p
Amputation
Debridement
Grade I
0
1
1
0.199
Grade II
0
4
4
Grade III
0
1
1
Grade IV
2
1
3
Grade V
2
1
3
4
8
12
Based on the results of the Association Test between Wagner Grade and
Diabetic Foot Therapy, the p-value is 0.199 ,. Because the significance value (p)
is greater than =5%, the hypothesis H0 is accepted. This means that the Wagner
Grade variable with Diabetic Foot Therapy has an insignificant relationship.
A. Discussion
Profile of Pedis Gas Gangrene Patients with Type II Diabetes Mellitus at
Bhayangkara Hospital Kediri Period January 2021-March 2022 was studied using
a cohort retrospective design (Non Experimental Design) method by counting the
number of gas gangrene patients with type II diabetes mellitus in Bhayangkara
Hospital Kediri with several variables that have been determined previously, and
the results obtained H0 are acceptable / there are no significant results, which
means that the therapeutic target & treatment outcome varies between patients
with Pedis gas gangrene with p> 0.05.
Some of the variables listed, some of which are not in accordance with the
research conducted by Henry Setiawan with the secondary data observation
method, it was found that the results of the univariate analysis showed that the
average duration of diabetes > 2 years was 52.3% and the majority were male.
50.6% male with p < 0.05 or H1 is acceptable. The results of research conducted
by researchers suggest that, Gas gangrene pedis is an infection, ulceration, and or
destruction of deep connective tissue associated with neuropathy and vascular
disease. Patients who have a history of non-routine control because of their DM
treatment, there is a high possibility of worsening progression of the patient's gas
gangrene condition, one of which causes metabolic neuropathy with different
therapeutic outcomes for each patient because the tissue damage suffered by each
gas gangrene pedis patient is different. different from wound healing which is
faster in women 20-40% compared to men (Rina et al., 2016).
Research conducted by Hasneli, 2017 on the identification and analysis of
blood sugar in diabetic patients, in 34 DM patients who were randomly assigned
to obtain a median of 311.5 mg/dL with a minimum and maximum value of 195
Eduvest – Journal of Universal Studies
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mg/d: and 500 mg/dL, with a value of normal fasting blood sugar < 100 mg/dL. It
was found that patients suffering from gas gangrene pedis with a median of 7 had
a minimum value of 3 and a maximum of 9 on the left foot, 4 on the right foot and
9, which means that the blood sugar level of diabetic patients above normal can
result in the sensitivity of the feet of patients with type II diabetes mellitus, this
proves that different symptoms between patients which means that they are not
significant or H0 are acceptable (Wahyuni, 2018) where the theory and results of
the study are the same as the results of the studies previously discussed, especially
with regard to the results of patients' blood sugar and type II diabetes mellitus.
Neurovascular disorders in diabetics include three neuropathy that occurs ,
namely: sensory neuropathy, motor neuropathy, autonomic neuropathy. Patients
with type II diabetes mellitus who experience gangrene pedis suffer from vascular
abnormalities in the form of ischemia, this is due to the macroangiopathic process
and decreased tissue circulation which is characterized by loss or reduction of
pulse of the dorsalis pedis artery, tibial artery and popliteal artery causing the feet
to become atrophic, cold and nails thicken. . This often leads to complications in
the form of Avascular Necrosis, Charcott disease, and/or Osteomyelitis in
patients, starting from the tip of the foot or leg. The classification obtained in
patients with gangrene pedis uses the Wagner-Meggit classification in the 1970s
which has been developed and found there are 5 degrees with degrees 4 and 5
which are gangrene pedis on the soles of the feet and all over the feet (Buboltz &
Murphy-Lavoie, 2019). Complications and clinical manifestations of each patient
are different, based on the etiology of the condition of the patient's gangrene
pedis. The cause of gangrene in patients with type II diabetes mellitus is anaerobic
bacteria, the most common of which are Clostridium difficile, Pseudomonas
aeruginosa because these bacteria produce gas and cause angiopathy. This theory
is in accordance with what has been studied previously regarding the grading of
diabetic foot / gangrene pedis based on Wagner-Meggitt, bacterial culture, disease
complications that occur which have a theoretical relationship, but the incidence
of each patient with different outcomes causes H0 to be accepted or not
significant (Wahyuni, 2018).
Ischemic foot is characterized by reduced blood supply. However, in this
situation, there are already neuropatic abnormalities at various stages. The patient
complains of leg pain when standing, walking or doing other physical activities.
The foot is cold, the posterior tibial or popliteal pulse is difficult to palpate. An
ulcer was found due to local pressure on the patient's leg. The ulcer is difficult to
heal and eventually becomes gangrene. Treatment of gas gangrene can be done by
bed rest and control of blood glucose levels with diet, insulin or OAD,
debridement of the patient's leg wound. Administration of topical antibiotics
according to culture results or with broad-spectrum antibiotics. For the prevention
of angiopathy can be given aspirin, dipyridamole. Surgery, namely immediate
amputation, debridement and drainage can be carried out according to the existing
grading or medical indications in patients with gangrene pedis (Cruz et al., 2021).
In accordance with the results of existing studies, that the action or therapy given
to patients has different indications, outcomes with the same goal of improving
the condition of patients with gangrene pedis, which means it is not significant.
Based on the description above, this study is a descriptive study, because
the results of the study provide an overview of the profile of gangrene pedis
R. Mohamad Javier, Yuswar Nurullah Sukin, Mochamad Yunus
Profile Of Pedis Gas Gangrene Patients With Type II Diabetes Mellitus At
Bhayangkara Hospital Kediri Period January 2021 - March
1879
patients with type II diabetes mellitus in the secondary data at Bhayangkara
Hospital, Kediri according to the specified period, and see the number of patients
who have been included according to the variable criteria specified. determined.
The weakness in this study is that there is no analytical study that explains
which therapy has the most effect on patients, only descriptive statistics are
explained because of the limited number of patients and pus culture is performed,
so the number (n) is not sufficient for retrospective analytical studies.
This research is still an early study that has weaknesses and limitations, so
further research is needed regarding the effect of analytical gangrene pedis
therapy with type II diabetes mellitus to find out which therapy is the most
effective or has an effect on patients according to their respective grading.
CONCLUSION
Based on the results of research and discussion in this study, the following
conclusions can be drawn:
1. Blood sugar levels of diabetic patients above normal can result in decreased
foot sensitivity of patients with type II diabetes mellitus.
2. Patients who have a history of non-routine control because of their DM
treatment, there is a high possibility of worsening progression of the patient's
gas gangrene condition, one of which causes metabolic neuropathy with
different therapeutic outcomes for each patient because the tissue damage
suffered by each gas gangrene pedis patient is different. different from wound
healing which is 20-40% faster in women than men.
3. The most causative bacteria based on the results of the study were
Pseudomonas aeruginosa with a result of n = 4. And the most frequently
performed action on gas gangrene pedis patients was debridement with n = 8.
Some patients who had a high level or grading did not choose to be amputated
but only performed debridement only.
4. Patients with type II diabetes mellitus who experience gangrene pedis suffer
from vascular abnormalities in the form of ischemia, in the form of Avascular
Necrosis, Charcott disease, and/or Osteomyelitis in patients. From the results
of the study, it was found that the most frequent complication was avascular
necrosis with n = 5 compared to the incidence of other complications.
5. Based on the description above, this study is a descriptive study, because the
results of the study provide an overview of the profile of gangrene pedis
patients with type II diabetes mellitus in the secondary data at Bhayangkara
Hospital, Kediri according to the specified period, and see the number of
patients who have been included according to the variable criteria specified.
determined.
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