Wet gangrene
Background
Gangrene General Info
- A form of tissue necrosis characterized by critically insufficient blood supply leading to tissue death.
- Primarily divided into wet gangrene vs dry gangrene. Other, specific forms of gangrene include Fournier's gangrene, gas gangrene, and necrotizing fasciitis.
- Most commonly occur in distal extremities, clasically the feet.
- Main risk factors are diabetes, smoking, and peripheral arterial disease.
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
Workup
- CBC
- Chemistry
- Consider:
- X-ray
- blood cultures
- lactate
Diagnosis
- 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 sepsis
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.
Disposition
- Admission