Dry gangrene
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Background
- 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.
- Mainstays of treatment include surgical debridement and antibiotics.
Clinical Features
- Usually due to peripheral arterial disease, but can also be caused by acute limb ischemia.
- Presents with dry, shrunken tissue, usually ranging from dark red to completely black, often with a clear line of demarcation between healthy and necrotic tissue. Typically not painful.
Differential Diagnosis
Evaluation
- History and physical examination are usually sufficient to make the diagnosis. If acute limb ischemia is suspected, consider a CTA of the affected limb and a vascular surgery consultation.
Management
- Infection rarely present, so management involves keeping the area clean and dry to prevent infection. Will usually auto-amputate in <6 months. Should be referred to vascular surgery as auto-amputation may not occur, and they may benefit from revascularization therapies to prevent further tissue death.
- If acute limb ischemia is present, embolectomy or surgical bypass may be required to restore flow.