A complication of necrosis characterised by the decay of body tissues. Results from ischaemia, infection, or trauma (or a combination of these processes).
Two main categories: infectious gangrene (which includes necrotising fasciitis and gas gangrene) and ischaemic gangrene (which can arise from arterial or venous obstruction).
Risk factors include diabetes, smoking, atherosclerosis, renal disease, drug and alcohol abuse, malignancy, trauma or abdominal surgery, contaminated wounds, malnutrition, hypercoagulable states, and prolonged use of tourniquets.
Successful treatment of infectious gangrene requires early recognition and a combination of aggressive surgical debridement, appropriate intravenous antibiotics, and intensive supportive care.
Ischaemic gangrene requires revascularisation for obstruction and thromboembolism, along with optimal treatment of any underlying disease. Measures to prevent superimposed infection must also be performed.
Prognosis is highly variable, but can involve significant morbidity and mortality.
Gangrene is a complication of necrosis characterised by the decay of body tissues. There are two major categories: infectious gangrene (wet gangrene) and ischaemic gangrene (dry gangrene). The condition may result from ischaemia, infection, or trauma (or a combination of these processes). Ischaemia may result from either arterial or venous compromise, and may be an acute or chronic process (or a combination of both). Critically insufficient blood supply is the most common cause of gangrene, and is often associated with diabetes and long-term smoking.
History and exam
- diabetes mellitus
- atherosclerosis (ischaemic gangrene)
- smoking (ischaemic gangrene)
- renal disease
- drug and alcohol abuse
- trauma or abdominal surgery (infectious gangrene)
- contaminated wounds (infectious gangrene)
- malnutrition (infectious gangrene)
- hypercoagulable states (ischaemic gangrene)
- prolonged application of tourniquets (ischaemic gangrene)
- 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
Department of Medicine
JJ declares that he has no competing interests.
Department of Medicine
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.
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