Dry 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
  • 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.

Differential Diagnosis

Foot infection

Look A-Likes

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
  • Keep area clean and dry to prevent infection
  • 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
  • If acute limb ischemia is present, embolectomy or surgical bypass may be required to restore flow.

Disposition

See Also


References
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