Skin & Soft Tissue: Gangrene

Definitions

• Gangrene: Necrosis of a Large Area of Mixed Tissues Due to Ischemia/Inadequate Blood Supply
• Types:
  • Dry Gangrene: Noninfected Tissue Necrosis from Ischemia
    • Aseptic – Bacterial Fail to Survive in Dry Mummified Tissue
  • Wet Gangrene: Infected Tissue Necrosis
    • Can Be a Progression of Dry Gangrene Complicated by a Secondary Infection
  • Gas Gangrene: Necrotizing Infection by Gas-Forming Organisms

Causes

• Ischemia:
  • Atherosclerosis & Peripheral Arterial Disease (PAD) – Most Common
  • Thromboembolism
  • Trauma
  • Vasculitis
  • May Be a Progression of Acute Limb Ischemia (ALI)
• Infection

Gas Gangrene (Clostridial Myonecrosis)

• *See Skin & Soft Tissue: Necrotizing Soft Tissue Infection (NSTI)

Presentation

• Dry Gangrene:
  • Dried & Shrunken Mummified Tissue
  • Black Color from Iron Sulfide Deposition from Hemoglobin Degradation
  • Painful
• Wet Gangrene:
  • Edema
  • Erythema
  • Purulent Drainage
  • Malodorous

Treatment

• Dry Gangrene
  • Medical Management:
    • Antiplatelet Therapy (Aspirin or Clopidogrel/Plavix)
    • Statins
    • Smoking Cessation
    • Glucose Control
  • Surgical Management:
    • Revascularization as Indicated (Primary Focus)
      • Restore Blood Flow & Minimize Tissue Loss
        • Gangrenous Tissue is Unlikely to Completely Recover
      • Endovascular Intervention or Surgical Bypass
    • Small Area/Toes: Allow Autoamputation (Spontaneous Separation of Nonviable Tissue from the Viable Tissue)
    • Large Area: Surgical Amputation
• Wet/Gas Gangrene
  • Primary Treatment: Urgent Surgical Debridement & Antibiotics
  • May Also Require Fasciotomy or Amputation