“Life and Lower Limb Threatening Condition” Clinical Features, Management and Outcomes of Diabetic Foot Ulcers Complicated by Gas Gangrene: A Prospective Cohort Study

Diabetic foot ulcer (DFU) is a common complication of diabetes in low- and middle-income countries and may be complicated by gas gangrene (GG), a rapidly progressive, life-threatening infection. This prospective study assessed whether GG can be diagnosed clinically in low-resource primary care and explored factors associated with wound-healing outcomes in DFU complicated by GG. From December 2021 to June 2025, consecutive patients with diabetic foot infection and clinically active GG were enrolled. Data included demographics, ulcer history and examination, SINBAD classification, GG signs, sepsis status, comorbidities, management, and outcomes. All participants had classical clinical features of GG and were admitted for urgent surgical treatment. Ninety-nine patients (58 male) with classical GG were admitted for urgent surgery. Initial amputation was required in 18% (major 12%, minor 6%). Ten patients were lost to follow-up; that included six who died from foot-ulcer-related causes. Of 89 followed, 30 (33.7%) healed in 225.5 ± 126.9 days, while 59 remained unhealed after 146.1 ± 175.4 days; major amputations during treatment were more frequent in the healed group. Having a previous history of ulcer showed to increase the time to heal by 136 days. A one-day increase in treatment duration was associated with a 1% decrease in both the chance of healing or risk of amputation. Early diagnosis, aggressive medical and surgical intervention are the keys to decreasing morbidity and mortality of diabetic patients with gas gangrene; and remain the mainstay treatment of this dangerous condition globally. Patient's with previous ulcer history were found to need longer time to heal. Increasing treatment duration seems to be a double-edged sword, as while it is associated with reduced risk of amputation, it also decreases the chance of ulcer healing.