Describes By : Dr. Francis Low



Gangrene is the most serious symptomatic feature or cardinal sign of arterial insufficiency, after intermittent claudication and rest pain. Gangrene is necrosis or death of tissue, and commonly affects the extremities of the hands and feet (Hoffman 1992).

When presented with gangrene, the clinician must determine the cause of the pathology, so as to address it and prevent further damage. Whilst ischaemia may be evaluated as being the cause, it should be determined whether it was from atherosclerosis, myocardial infarct, valvular heart disease or emboli. Also ascertain if they are a smoker, have diabetes mellitus, and history of vascular problems. Treating gangrene is beyond the scope of a podiatrist, so if gangrene is found, refer to a vascular surgeon.

The podiatrist may see gangrene as dry or moist (Hoffman 1992). Dry gangrene is most commonly due to ischaemia and is often a secondary complication of type 2 diabetes mellitus. It presents as cold, dry, shriveled and blackened tissue, often running deep into the fascia, but first appearing on the distal apices.

Wet or moist gangrene is the more serious condition, as it usually indicates a bacterial infection that may quickly spread and be fatal. Most commonly caused by an acute occlusion, such as tourniquet, restrictive bandage or trauma. It present like dry gangrene, but is softer to touch with an offensive odour, and the foot may be swollen, red and warm (Lorimer et al, 1997, Hoffman 1992).

As mentioned previously, presence of gangrene must be taken seriously and appropriate referrals made immediately.

More horrifying Pictures on Gangrene
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