Dry gangrene - Revision history

Patricklin at 22:49, 6 June 2025

2025-06-06T22:49:04Z

← Older revision		Revision as of 22:49, 6 June 2025
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	[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]		[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]
	[[File:Gangrenous foot 2013-05-26 17-24.jpg\|thumb\|Dry gangrene of foot.]]		[[File:Gangrenous foot 2013-05-26 17-24.jpg\|thumb\|Dry gangrene of foot.]]
	* ~~Usually~~ due to [[peripheral arterial disease]], but can also be caused by [[acute limb ischemia]].		* Dry gangrene is tissue necrosis often due to chronic progressive ischemia from [[peripheral arterial disease]], but can also be caused by [[acute limb ischemia]].
	* Presents with dry, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.		* Presents with dry, cold, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.
	*Typically not painful.		**Usually not associated with infection (in contrast to [[Wet gangrene]]) as bacteria cannot survive in the dry/mummified tissue; however, development of secondary infection is possible<ref>Buttolph A, Sapra A. Gangrene. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560552/</ref>
			*Typically not painful due to associated nerve death
			*Nonpalpable pulses are common

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	* History and physical examination are usually sufficient to make the diagnosis.		*History and physical examination are usually sufficient to make the diagnosis.
			*Consider [[ABI]] or pulse volume recording (PVR) for early evaluation of [[peripheral arterial disease]].
	*If [[acute limb ischemia]] is suspected, consider a CTA of the affected limb and a vascular surgery consultation.		*If [[acute limb ischemia]] is suspected, consider a CTA of the affected limb and a vascular surgery consultation.
	*If has any areas consistent with [[wet gangrene]] or surrounding [[SSTI]], treat as for those entities

	==Management==		==Management==
	*Infection rarely present		*Infection rarely present
	**<8% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>		**<8% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>
	*Keep area clean and dry to prevent infection; consider debridement		**If has any areas consistent with [[wet gangrene]] or surrounding [[SSTI]] or [[Necrotizing fasciitis]], treat as for those entities
	*~~Will~~ usually ~~auto-amputate~~ in <6mo		**Keep area clean and dry to prevent infection; consider debridement
	*Refer to vascular surgery in ~~case fails to auto~~-~~amputate~~; ~~may benefit from revascularization therapy to prevent further tissue death~~.		*Early involvement of vascular surgery
			**Although revascularization is possible for chronic ischemia, dry gangrene signifies that the tissue is already necrotic
			**Amputation is often the treatment of choice for significant necrosis; patients could also await autoamputation, which usually occurs in <6mo <ref> Al Wahbi A. Operative versus non-operative treatment in diabetic dry toe gangrene. Diabetes Metab Syndr. 2019 Mar-Apr;13(2):959-963. doi: 10.1016/j.dsx.2018.12.021. Epub 2018 Dec 27. PMID: 31336551.</ref>
	**Diabetes or immunocompromise may warrant lower threshold for consultation <ref> Rodrigues J, Mitt N. Diabetic Foot and Gangrene. Gangrene - Current Concepts and Management Options. Published online August 29, 2011. doi:https://doi.org/10.5772/23994 </ref>		**Diabetes or immunocompromise may warrant lower threshold for consultation <ref> Rodrigues J, Mitt N. Diabetic Foot and Gangrene. Gangrene - Current Concepts and Management Options. Published online August 29, 2011. doi:https://doi.org/10.5772/23994 </ref>
	*If [[acute limb ischemia]] is present, embolectomy or surgical bypass may be required to restore flow.		*If [[acute limb ischemia]] is present, embolectomy or surgical bypass may be required to restore flow.
			*Ensure patient has adequate medical management of predisposing risk factors

	==Disposition==		==Disposition==
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	==See Also==		==See Also==
	*[[~~Gangrene~~]]		*[[Wet gangrene]]

	==External Links==		==External Links==

Rossdonaldson1: /* Clinical Features */

2025-05-21T18:40:14Z

Clinical Features

← Older revision		Revision as of 18:40, 21 May 2025
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	[[File:Acral gangrene due to plague.jpg\|thumb\|Dry gangrene of fingertips.]]		[[File:Acral gangrene due to plague.jpg\|thumb\|Dry gangrene of fingertips.]]
	[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]		[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]
			[[File:Gangrenous foot 2013-05-26 17-24.jpg\|thumb\|Dry gangrene of foot.]]
	* Usually due to [[peripheral arterial disease]], but can also be caused by [[acute limb ischemia]].		* Usually due to [[peripheral arterial disease]], but can also be caused by [[acute limb ischemia]].
	* Presents with dry, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.		* Presents with dry, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.

Rossdonaldson1: /* Evaluation */

2025-05-21T18:34:58Z

Evaluation

← Older revision		Revision as of 18:34, 21 May 2025
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	* History and physical examination are usually sufficient to make the diagnosis.		* History and physical examination are usually sufficient to make the diagnosis.
	*If [[acute limb ischemia]] is suspected, consider a CTA of the affected limb and a vascular surgery consultation.		*If [[acute limb ischemia]] is suspected, consider a CTA of the affected limb and a vascular surgery consultation.
	*If has any areas consistent with [[wet gangrene]], treat as for ~~[[wet gangrene]]~~		*If has any areas consistent with [[wet gangrene]] or surrounding [[SSTI]], treat as for those entities

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2025-05-21T18:33:42Z

Evaluation

← Older revision		Revision as of 18:33, 21 May 2025
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	==Evaluation==		==Evaluation==
	* History and physical examination are usually sufficient to make the diagnosis.		* History and physical examination are usually sufficient to make the diagnosis.
	*If acute limb ischemia is suspected, consider a CTA of the affected limb and a vascular surgery consultation.		*If [[acute limb ischemia]] is suspected, consider a CTA of the affected limb and a vascular surgery consultation.
			*If has any areas consistent with [[wet gangrene]], treat as for [[wet gangrene]]

	==Management==		==Management==

Rossdonaldson1: /* Clinical Features */

2025-05-21T18:31:23Z

Clinical Features

← Older revision		Revision as of 18:31, 21 May 2025
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	==Clinical Features==		==Clinical Features==
			[[File:Dry gangene 4th toe.jpg\|thumb\|Dry gangrene of toe.]]
	[[File:Acral gangrene due to plague.jpg\|thumb\|Dry gangrene of fingertips.]]		[[File:Acral gangrene due to plague.jpg\|thumb\|Dry gangrene of fingertips.]]
	[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]		[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]

Rossdonaldson1: /* Clinical Features */

2025-05-21T18:29:33Z

Clinical Features

← Older revision		Revision as of 18:29, 21 May 2025
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	==Clinical Features==		==Clinical Features==
	[[File:Dry Gangrene.png\|thumb]]		[[File:Acral gangrene due to plague.jpg\|thumb\|Dry gangrene of fingertips.]]
			[[File:Dry Gangrene.png\|thumb\|Dry gangrene of foot.]]
	* Usually due to [[peripheral arterial disease]], but can also be caused by [[acute limb ischemia]].		* Usually due to [[peripheral arterial disease]], but can also be caused by [[acute limb ischemia]].
	* Presents with dry, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.		* Presents with dry, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.

Rossdonaldson1: /* Management */

2025-05-21T18:26:36Z

Management

← Older revision		Revision as of 18:26, 21 May 2025
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	==Management==		==Management==
	*Infection rarely present~~; approximately 7.7~~% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>		*Infection rarely present
			**<8% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>
	*Keep area clean and dry to prevent infection; consider debridement		*Keep area clean and dry to prevent infection; consider debridement
	*Will usually auto-amputate in <6mo		*Will usually auto-amputate in <6mo
	*Refer to vascular surgery in case fails to auto-amputate; may benefit from revascularization therapy to prevent further tissue death. Diabetes or immunocompromise may warrant lower threshold for consultation <ref> Rodrigues J, Mitt N. Diabetic Foot and Gangrene. Gangrene - Current Concepts and Management Options. Published online August 29, 2011. doi:https://doi.org/10.5772/23994 </ref>		*Refer to vascular surgery in case fails to auto-amputate; may benefit from revascularization therapy to prevent further tissue death.
			**Diabetes or immunocompromise may warrant lower threshold for consultation <ref> Rodrigues J, Mitt N. Diabetic Foot and Gangrene. Gangrene - Current Concepts and Management Options. Published online August 29, 2011. doi:https://doi.org/10.5772/23994 </ref>
	*If [[acute limb ischemia]] is present, embolectomy or surgical bypass may be required to restore flow.		*If [[acute limb ischemia]] is present, embolectomy or surgical bypass may be required to restore flow.

Cole Ettingoff: /* Management */

2025-05-03T23:14:06Z

Management

← Older revision		Revision as of 23:14, 3 May 2025
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	==Management==		==Management==
	*Infection rarely present; approximately 7.7% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>		*Infection rarely present; approximately 7.7% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>
	*Keep area clean and dry to prevent infection		*Keep area clean and dry to prevent infection; consider debridement
	*Will usually auto-amputate in <6mo		*Will usually auto-amputate in <6mo
	*Refer to vascular surgery in case fails to auto-amputate; may benefit from revascularization therapy to prevent further tissue death		*Refer to vascular surgery in case fails to auto-amputate; may benefit from revascularization therapy to prevent further tissue death. Diabetes or immunocompromise may warrant lower threshold for consultation <ref> Rodrigues J, Mitt N. Diabetic Foot and Gangrene. Gangrene - Current Concepts and Management Options. Published online August 29, 2011. doi:https://doi.org/10.5772/23994 </ref>
	*If [[acute limb ischemia]] is present, embolectomy or surgical bypass may be required to restore flow.		*If [[acute limb ischemia]] is present, embolectomy or surgical bypass may be required to restore flow.

Cole Ettingoff: /* Management */

2025-05-03T23:08:12Z

Management

← Older revision		Revision as of 23:08, 3 May 2025
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	==Management==		==Management==
	*Infection rarely present; approximately 7.7% of cases convert to wet gangrene		*Infection rarely present; approximately 7.7% of cases convert to wet gangrene <ref> Latz CA et.al. Rates of conversion from dry to wet gangrene following lower extremity revascularization. Ann Vasc Surg. 2022;83:20–25. https://www.sciencedirect.com/science/article/pii/S0890509622000115. doi: 10.1016/j.avsg.2022.01.005. </ref>
	*Keep area clean and dry to prevent infection		*Keep area clean and dry to prevent infection
	*Will usually auto-amputate in <6mo		*Will usually auto-amputate in <6mo

Cole Ettingoff: /* Management */

2025-05-03T23:04:47Z

Management

← Older revision		Revision as of 23:04, 3 May 2025
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	==Management==		==Management==
	*Infection rarely present		*Infection rarely present; approximately 7.7% of cases convert to wet gangrene
	*Keep area clean and dry to prevent infection		*Keep area clean and dry to prevent infection
	*Will usually auto-amputate in <6mo		*Will usually auto-amputate in <6mo