Wet gangrene

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

• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Gangrene
  • Dry gangrene
  • Wet gangrene
  • Gas gangrene
• Diabetic foot infection
• Trench foot

Bone and Joint

• Osteomyelitis
• Septic arthritis
• Septic bursitis

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.

See Also

• Gangrene