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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.
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Management and Disposition
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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.
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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.
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