Wet gangrene: Difference between revisions
 
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==Clinical Features==
==Clinical Features==
[[File:DMgas gangrene.jpg|thumb|Wet gangrene with presumed gas.]]
[[File:Nekrose avk03.jpg|thumb|Wet gangrene of foot.]]
* Usually due to peripheral arterial or venous disease, but can also be sequelae of trauma or burns causing vascular injuries.  
* 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.  
* Presents with swollen, pale, soft tissue, often with a putrid smell and purulent discharge.  
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==Evaluation==
==Evaluation==
===Workup===
*CBC
*Chemistry
*Consider:
**X-ray
**[[blood cultures]]
**[[lactate]]
===Diagnosis===
* History and physical examination are usually sufficient to make the 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 SIRS/sepsis, including a CBC, and possibly blood cultures and lactate if systemic infection is suspected.
* Given higher risk for systemic infection, patients should be evaluated for signs/symptoms of [[sepsis]]


==Management==
==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.
* Requires surgical consultation as rapid debridement or amputation of necrotic tissue is required to prevent further spread of infection.
===Antibiotics===
''Initial use broad spectrum antibiotic coverage, as these are often polymycrobial infections.''
*Example 1:
**[[Cefepime]] 1g IV q24h [infuse first] +
**[[Metronidazole]] 500mg IV q8h +
**[[Vancomycin]] 1g IV (or per pharmacy) +
**Consider additionally: [[clindamycin]] 900mg IV q8h (if suspect anerobic/gas gangrene/[[streptococcal toxic shock syndrome]])
*Example 2 (possible substitutions):
**Substitute [[piperacillin-tazobactam]] OR [[meropenem]] for broad-spectrum coverage
**Substitute [[linezolid]] for [[MRSA]] coverage
**Substitute [[penicillin G]] for anaerobic coverage.


==Disposition==
==Disposition==
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==References==
==References==
<references/>
<references/>
[[Category:Surgery]]

Latest revision as of 19:49, 21 May 2025

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

Wet gangrene with presumed gas.
Wet gangrene of foot.
  • 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

Look A-Likes

Evaluation

Workup

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

  • Requires surgical consultation as rapid debridement or amputation of necrotic tissue is required to prevent further spread of infection.

Antibiotics

Initial use broad spectrum antibiotic coverage, as these are often polymycrobial infections.

Disposition

  • Admission

See Also

External Links

References

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