Wet gangrene: Difference between revisions
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Revision as of 04:22, 30 October 2017
Background
Clinical Features
- Usually due to peripheral arterial or venous disease, but can also be sequelae of trauma or burns causing vascular injuries.
- Presents with swollen, pale, soft tissue, often with a putrid smell and purulent discharge.
- As tissue is infected, wet gangrene presents a higher risk of systemic infection than dry gangrene.
Differential Diagnosis
Foot infection
Skin and Soft Tissue
- Cellulitis
- Erysipelas
- Abscess
- Puncture wound infection
- Paronychia
- Ingrown toenail (infected)
- Tinea pedis
- Infected wound / diabetic foot ulcer
Deep Tissue / Limb-Threatening
Bone and Joint
Look A-Likes
- Gout
- Pseudogout
- Charcot foot
- Peripheral artery disease
- Deep venous thrombosis
- Venous stasis dermatitis
- Sporotrichosis
- Contact dermatitis
- Calciphylaxis
- Lymphedema
- Erythema nodosum
- Stress fracture
- Reactive arthritis
Evaluation
- History and physical examination are usually sufficient to make the diagnosis.
- Given higher risk for systemic infection, patients should be evaluated for signs/symptoms of SIRS/sepsis, including a CBC, and possibly blood cultures and lactate if systemic infection is suspected.
Management
- Wet gangrene requires broad spectrum antibiotic coverage, as these are often polymycrobial infections.
- Requires surgical consultation as rapid debridement or amputation of necrotic tissue is required to prevent further spread of infection.