Wet gangrene

Background

Gangrene General Info

• A form of tissue necrosis characterized by critically insufficient blood supply leading to tissue death.
• Primarily divided into wet gangrene vs dry gangrene. Other, specific forms of gangrene include Fournier's gangrene, gas gangrene, and necrotizing fasciitis.
• Most commonly occur in distal extremities, clasically the feet.
• Main risk factors are diabetes, smoking, and peripheral arterial disease.

Clinical Features

Wet gangrene with presumed gas.

• Usually due to peripheral arterial or venous disease, but can also be sequelae of trauma or burns causing vascular injuries.
• Presents with swollen, pale, soft tissue, often with a putrid smell and purulent discharge.
• As tissue is infected, wet gangrene presents a higher risk of systemic infection than dry gangrene.

Differential Diagnosis

Foot infection

• Gout
• PsuedoGout
• Cellulitis
• Gangrene
  • Dry gangrene
  • Wet gangrene
• Trench foot
• Abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Osteomyelitis
• Diabetic foot infection
• Charcot Foot

Look A-Likes

• Peripheral artery disease
• Sporotrichosis
• Deep venous thrombosis

Evaluation

Workup

• CBC
• Chemistry
• Consider:
  • X-ray
  • blood cultures
  • lactate

Diagnosis

• History and physical examination are usually sufficient to make the diagnosis.
• Given higher risk for systemic infection, patients should be evaluated for signs/symptoms of sepsis

Management

• Wet gangrene requires broad spectrum antibiotic coverage, as these are often polymycrobial infections.
• Requires surgical consultation as rapid debridement or amputation of necrotic tissue is required to prevent further spread of infection.

Antibiotics

Coverage	Drugs
Broad-spectrum (typical start)	Piperacillin-tazobactam OR meropenem OR cefepime + metronidazole
MRSA	Add vancomycin or linezolid
Anaerobic/gas gangrene	Penicillin G + clindamycin
Polymicrobial (common in diabetics)	Carbapenem monotherapy or combo therapy (e.g., ceftriaxone + metronidazole + vancomycin)

Disposition

• Admission

See Also

• Gangrene