Limb Ulceration and Gangrene - Gangrene Flashcards
What is Wet Gangrene?
Infectious gangrene, including necrotising fasciitis, gas gangrene and gangrenous cellulitis.
What is Necrotising Fasciitis?
Infection of the subcutaneous fascia and fat.
How does wet gangrene present?
Poorly demarcated from surrounding tissue and septic/pyrexial patient.
Management of wet gangrene (2).
- Surgical debridement.
2. Broad-Spectrum IV Antibiotics.
What is Dry Gangrene?
Ischaemic gangrene.
What is Dry Gangrene caused by (3)?
Chronically reduced blood flow :-
- Atherosclerosis (PAD).
- Thrombosis (Vasculitis, Hypercoagulability).
- Vasospasm (Cocaine, Raynaud’s).
How does dry gangrene present?
Well demarcated from surrounding tissue and patient does not show signs of infection - auto-amputation may occur in most cases.
Clinical Features of Gas Gangrene (5).
- Acute Onset of Severe Localised Pain.
- Darkened Skin.
- Spreading Erythema.
- Pyrexial.
- Infected area gives a distinctive potent smell.
Pathophysiology of Gas Gangrene (4).
- Bacterial Growth - gas production.
- Greater Carbohydrate Breakdown by C. perfringens - gas and acid creation in affected area.
- Vegetative bacteria produce toxins and hydrolytic enzymes.
- Toxic shock - cell damage can cause systemic effects e.g. hypotension.
Management of Gas Gangrene (4).
- Debridement urgently.
- Antibiotics.
- Amputation - Large margin (further development).
- Hyperbaric Oxygen Therapy - if bacteria are anaerobic.
What is Fournier’s Gangrene?
A form of Necrotising Fasciitis affecting the perineum - urological emergency.
Differentials of Fournier’s Gangrene (3).
- Cellulitis.
- Epididymo-Orchitis.
- Testicular Torsion.
Management of Fournier’s Gangrene (3).
- Surgical Debirdement - Total/Partial Orchiectomy.
- Broad-Spectrum Antibiotics.
- Transfer to High-Dependency Setting.
