Gangrene denotes tissue with lost blood supply and undergoing necrosis. The term dry gangrene is used for tissues undergoing sterile ischemic coagulative necrosis. Patients with atherosclerotic disease and diabetes are at risk for the development of dry gangrene, usually because of embolization to the forefoot or toe. Wet gangrene is associated with bacterial proteolytic decomposition and is characterized by its moist appearance, frequently with blistering.
Management and Disposition
Hospitalization is usually required. The treatment consists of amputation, debridement, and antibiotic therapy as needed. Wet gangrene requires emergent surgical consultation. Underlying vascular pathology must be evaluated and corrected surgically or endovascularly. Patients with systemic toxicity should be resuscitated aggressively.
Dry Gangrene. Dry gangrene of the toes showing the areas of total tissue death, appearing as black and lighter shades of discoloration of the skin demarcating areas of impending gangrene. (Photo contributor: Lawrence B. Stack, MD.)
Obtain radiographs to help rule out clostridial myonecrosis (gas gangrene, see related item) and osteomyelitis.
Aggressive surgical debridement is necessary for cure in most cases of wet gangrene.
Dry Gangrene. Complete tissue death characterized by black, desiccated tissue, and lighter areas demarcating areas of impending gangrene. (Photo contributor: David Effron, MD.)
Wet Gangrene. Note the moist appearance and blistering due to bacterial proteolytic decomposition of gangrenous tissue. (Photo contributor: Robert Tubbs, MD.)