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Gangrene

Последний просмотренный: 20 Aug 2025
Last updated: 14 May 2025

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • pain
  • edema or swelling
  • skin discoloration
  • crepitus (gas gangrene)
Полная информация

Другие диагностические факторы

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

Факторы риска

  • diabetes mellitus
  • atherosclerosis (ischemic gangrene)
  • smoking (ischemic gangrene)
  • renal disease
  • drug and alcohol abuse
  • malignancy
  • trauma or abdominal surgery (infectious gangrene)
  • contaminated wounds (infectious gangrene)
  • immunosuppression (infectious gangrene)
  • malnutrition (infectious gangrene)
  • hypercoagulable states (ischemic gangrene)
  • prolonged application of tourniquets (ischemic gangrene)
  • community-acquired MRSA
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • CBC
  • comprehensive metabolic panel
  • serum LDH
  • coagulation panel
  • blood cultures
  • serum CRP
  • plain x-rays
  • CT of affected site
  • MRI of affected site
  • Doppler ultrasonography
Полная информация

Исследования, проведение которых нужно рассмотреть

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

Алгоритм лечения

Начальные

necrotizing fasciitis awaiting confirmation of microbial culture and sensitivity results

Острый

confirmed type I necrotizing fasciitis (polymicrobial)

confirmed type II necrotizing fasciitis (monomicrobial)

gas gangrene

ischemic gangrene

Составители

Авторы

Jason Jacob, MD

Attending Physician

Assistant Director

Department of Medicine

Hartford Hospital

Hartford

CT

Раскрытие информации

JJ declares that he has no competing interests.

Robert J. Gionfriddo, DO

Assistant Director

Department of Medicine

Hartford Hospital

Hartford

CT

Раскрытие информации

RJG declares that he has no competing interests.

Выражение благодарностей

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 topic.

Раскрытие информации

WT, BA, MA, JC, and IG declare that they have no competing interests.

Рецензенты

Meryl Davis, MD

Consultant Vascular Surgeon

Royal Free Hampstead

London

UK

Раскрытие информации

MD declares that she has no competing interests.

Charles Fox, MD

Vascular Surgeon

Department of Surgery

Walter Reed Army Medical Center

Washington

DC

Раскрытие информации

CF declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Kihiczak GG, Schwartz RA, Kapila R. Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol. 2006 Apr;20(4):365-9.Полный текст  Аннотация

Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.Полный текст  Аннотация

Nicolasora N, Kaul DR. Infectious disease emergencies. Med Clin North Am. 2008 Mar;92(2):427-41. Аннотация

Bradbury AW, Adam DJ, Bell J, et al; BASIL trial Participants. Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: an intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy. J Vasc Surg. 2010 May;51(5 Suppl):5-17S. Аннотация

Norgren L, Hiatt WR, Dormandy JA, et al.; TASC II Working Group. Inter-society consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg. 2007 Jan;45 Suppl S:S5-67.Полный текст  Аннотация

Статьи, указанные как источники

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