Dry gangrene: Difference between revisions
Patricklin (talk | contribs) No edit summary |
|||
| (17 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
{{Gangrene general info}} | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Dry Gangrene.png|thumb]] | [[File:Dry gangene 4th toe.jpg|thumb|Dry gangrene of toe.]] | ||
* | [[File:Acral gangrene due to plague.jpg|thumb|Dry gangrene of fingertips.]] | ||
* 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. Typically not painful | [[File:Dry Gangrene.png|thumb|Dry gangrene of foot.]] | ||
[[File:Gangrenous foot 2013-05-26 17-24.jpg|thumb|Dry gangrene of foot.]] | |||
* 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, cold, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue. | |||
**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== | ||
| Line 15: | Line 17: | ||
==Evaluation== | ==Evaluation== | ||
* 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. | *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. | |||
==Management== | ==Management== | ||
* Infection rarely present, | *Infection rarely present | ||
* If acute limb ischemia is present, embolectomy or surgical bypass may be required to restore flow. | **<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> | ||
**If has any areas consistent with [[wet gangrene]] or surrounding [[SSTI]] or [[Necrotizing fasciitis]], treat as for those entities | |||
**Keep area clean and dry to prevent infection; consider debridement | |||
*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> | |||
*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== | ||
*Outpatient, if [[acute limb ischemia]] is NOT a concern | |||
==See Also== | ==See Also== | ||
*[[ | *[[Wet gangrene]] | ||
==External Links== | ==External Links== | ||
| Line 32: | Line 45: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Surgery]] | |||
[[Category:Vascular]] | |||
Latest revision as of 22:49, 6 June 2025
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
- 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, cold, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue.
- 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[1]
- Typically not painful due to associated nerve death
- Nonpalpable pulses are common
Differential Diagnosis
Foot infection
- Gout
- PsuedoGout
- Cellulitis
- Gangrene
- Trench foot
- Abscess
- Necrotizing soft tissue infections
- Osteomyelitis
- Diabetic foot infection
- Charcot Foot
Look A-Likes
Evaluation
- 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.
Management
- Infection rarely present
- <8% of cases convert to wet gangrene [2]
- If has any areas consistent with wet gangrene or surrounding SSTI or Necrotizing fasciitis, treat as for those entities
- Keep area clean and dry to prevent infection; consider debridement
- 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 [3]
- Diabetes or immunocompromise may warrant lower threshold for consultation [4]
- 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
- Outpatient, if acute limb ischemia is NOT a concern
See Also
External Links
References
- ↑ 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/
- ↑ 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.
- ↑ 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.
- ↑ 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