When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Gangrena

Ver PDF
  • Visão geral
  • Teoria
  • Diagnóstico
  • Tratamento
  • ACOMPANHAMENTO
  • Recursos
Última revisão: 11 Dec 2025
Última atualização: 14 May 2025

Resumo

Definition

History and exam

Key diagnostic factors

  • presença de fatores de risco
  • dor
  • edema ou inchaço
  • descoloração da pele
  • crepitação (gangrena gasosa)
Full details

Other diagnostic factors

  • pulso pedioso diminuído e índice tornozelo-braquial (gangrena isquêmica)
  • febre baixa e calafrios (gangrena infecciosa)
Full details

Risk factors

  • diabetes mellitus
  • aterosclerose (gangrena isquêmica)
  • tabagismo (gangrena isquêmica)
  • doença renal
  • abuso de álcool e drogas
  • neoplasia maligna
  • trauma ou cirurgia abdominal (gangrena infecciosa)
  • feridas infectadas (gangrena infecciosa)
  • imunossupressão (gangrena infecciosa)
  • desnutrição (gangrena infecciosa)
  • estados hipercoaguláveis (gangrena isquêmica)
  • aplicação prolongada de torniquetes (gangrena isquêmica)
  • MRSA adquirido na comunidade
Full details

Diagnostic investigations

1st investigations to order

  • Hemograma completo
  • perfil metabólico completo
  • lactato desidrogenase (LDH) sérico
  • painel da coagulação
  • hemoculturas
  • proteína C-reativa sérica
  • radiografias simples
  • tomografia computadorizada (TC) do local afetado
  • ressonância nuclear magnética (RNM) do local afetado
  • ultrassonografia com Doppler
Full details

Investigations to consider

  • exploração cirúrgica e biópsia de pele
  • Angiotomografia
  • angiografia por ressonância magnética (ARM)
  • tomografia computadorizada (TC) do tórax e abdome
  • anticorpos antinucleares (ANA), anticoagulante lúpico, anticardiolipina e anticorpos antibeta-2-glicoproteína-1
  • aglutininas a frio séricas
  • criofibrinogênio sérico
  • crioglobulina plasmática
Full details

Treatment algorithm

INITIAL

fasciite necrosante aguardando confirmação de resultados de cultura microbiana e sensibilidade

ACUTE

fasciite necrosante do tipo I confirmada (polimicrobiana)

fasciite necrosante do tipo II (monomicrobiana) confirmada

gangrena gasosa

gangrena isquêmica

Contributors

Authors

Jason Jacob, MD

Attending Physician

Assistant Director

Department of Medicine

Hartford Hospital

Hartford

CT

Disclosures

JJ declares that he has no competing interests.

Robert J. Gionfriddo, DO

Assistant Director

Department of Medicine

Hartford Hospital

Hartford

CT

Disclosures

RJG declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Meryl Davis, MD

Consultant Vascular Surgeon

Royal Free Hampstead

London

UK

Disclosures

MD declares that she has no competing interests.

Charles Fox, MD

Vascular Surgeon

Department of Surgery

Walter Reed Army Medical Center

Washington

DC

Disclosures

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.

References

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.

Key articles

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

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.Full text  Abstract

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

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. Abstract

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.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Gangrena images

  • Differentials

    • Lesões cutâneas por estafilococos
    • Erisipela
    • Celulite
    More Differentials

  • Guidelines

    • 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease
    • Surgical site infections: prevention and treatment
    More Guidelines

  • Patient information

    Diabetes do tipo 2: devo tomar insulina?

    Diabetes: o que posso fazer para me manter saudável?

    More Patient information
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer