Gangrene: Difference between revisions
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== Dry Gangrene == | == Dry Gangrene == | ||
[[File: | [[File:Dry Gangrene.png]] | ||
=== Clinical Features === | === Clinical Features === | ||
* 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. | ||
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=== Management === | === Management === | ||
* 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. | * 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. | ||
* 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. | ||
== Wet Gangrene == | == Wet Gangrene == | ||
Revision as of 03:54, 30 October 2017
Background
- 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.
- Mainstays of treatment include surgical debridement and antibiotics.
Dry Gangrene
Clinical Features
- 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. Typically not painful.
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.
Management
- 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.
- If acute limb ischemia is present, embolectomy or surgical bypass may be required to restore flow.
Wet Gangrene
Clinical Features
- 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.
Evaluation
- 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 SIRS/sepsis, including a CBC, and possibly blood cultures and lactate if systemic infection is suspected.
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.