Last reviewed: November 2017
Last updated: September  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • pain
  • oedema (ischaemic gangrene)
  • skin discoloration
  • crepitus (gas gangrene)

Other diagnostic factors

  • diminished pedal pulses and ankle-brachial index (ischaemic gangrene)
  • low-grade fever and chills (infectious gangrene)

Risk factors

  • diabetes mellitus
  • atherosclerosis (ischaemic gangrene)
  • smoking (ischaemic gangrene)
  • renal disease
  • drug and alcohol abuse
  • malignancy
  • trauma or abdominal surgery (infectious gangrene)
  • contaminated wounds (infectious gangrene)
  • malnutrition (infectious gangrene)
  • hypercoagulable states (ischaemic gangrene)
  • prolonged application of tourniquets (ischaemic gangrene)

Diagnostic investigations

1st investigations to order

  • FBC
  • comprehensive metabolic panel
  • serum LDH
  • coagulation panel
  • blood cultures
  • serum C-reactive protein
  • plain x-rays
  • CT of affected site
  • MRI of affected site
  • Doppler ultrasonography
Full details

Investigations to consider

  • surgical exploration and skin biopsy
  • CT angiography
  • magnetic resonance angiography (MRA)
  • CT chest and abdomen
  • ANA, lupus anticoagulant, anticardiolipin, and anti beta2 glycoprotein-1 antibodies
  • serum cold agglutinins
  • serum cryofibrinogens
  • plasma cryoglobulin
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Attending Physician

Assistant Director

Department of Medicine

Hartford Hospital

Hartford

CT

Disclosures

JJ declares that he has no competing interests.

Assistant Director

Department of Medicine

Hartford Hospital

Hartford

CT

Disclosures

RJG declares that he has no competing interests.

Dr Jason Jacob and Dr Robert J. Gionfriddo would like to gratefully acknowledge Dr William Tennant, Dr Badr Aljabri, Dr Mohammed Al-Omran, Dr Jose Contreras-Ruiz, and Dr Iris Galvan-Martinez, the previous contributors to this monograph. WT, BA, MA, JC, and IG declare that they have no competing interests.

Peer reviewers VIEW ALL

Consultant Vascular Surgeon

Royal Free Hampstead

London

UK

Disclosures

MD declares that she has no competing interests.

Vascular Surgeon

Department of Surgery

Walter Reed Army Medical Center

Washington

DC

Disclosures

CF declares that he has no competing interests.

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