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| == Background ==
| | *[[Dry gangrene]] |
| * A form of tissue necrosis characterized by critically insufficient blood supply leading to tissue death.
| | *[[Wet gangrene]] |
| * 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.
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| * Main risk factors are diabetes, smoking, and peripheral arterial disease.
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| * Mainstays of treatment include surgical debridement and antibiotics.
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| == Dry Gangrene ==
| | [[Category:Surgery]] |
| [[File:Dry Gangrene.png]] | |
| === Clinical Features ===
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| * Usually due to peripheral arterial disease, but can also be caused by acute limb ischemia.
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| * 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.
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| === Evaluation ===
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| * 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.
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| === Management ===
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| * Infection rarely present, so management involves keeping the area clean and dry to prevent infection. Will usually auto-amputate in <6 months. Should be referred to vascular surgery as auto-amputation may not occur, and they may benefit from revascularization therapies to prevent further tissue death.
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| * If acute limb ischemia is present, embolectomy or surgical bypass may be required to restore flow.
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| == Wet Gangrene ==
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| === Clinical Features ===
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| * Usually due to peripheral arterial or venous disease, but can also be sequelae of trauma or burns causing vascular injuries.
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| * Presents with swollen, pale, soft tissue, often with a putrid smell and purulent discharge.
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| * As tissue is infected, wet gangrene presents a higher risk of systemic infection than dry gangrene.
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| === Evaluation ===
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| * History and physical examination are usually sufficient to make the diagnosis.
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| * Given higher risk for systemic infection, patients should be evaluated for signs/symptoms of SIRS/sepsis, including a CBC, and possibly blood cultures and lactate if systemic infection is suspected.
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| === Management ===
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| * Wet gangrene requires broad spectrum antibiotic coverage, as these are often polymycrobial infections.
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| * Requires surgical consultation as rapid debridement or amputation of necrotic tissue is required to prevent further spread of infection.
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