Editing Foot gangrene


Gangrene - death and putrefaction of a body tissue.

* Dry
** Dry/desiccated
** Usually defined line of demarcation between dry and wet tissue
* Wet
** Affected tissue may still be partially perfused, retain some turgor
** No clear line of demarcation
* Gas
** Anaerobic bacteria (Clostridia) invade tissue and muscle and release gas and toxins
** Can be rapidly fatal


Essentially, it occurs because of inadequate blood flow to keep tissues viable. Therefore the goal of treatment is to increase blood flow.

* Most patients with gangrene in feet have some sort of arterial pathology
* Therefore entire vascular tree must be evaluated

== Aetiology ==

* Atheroembolic
* Occlusive
* Myeloproliferative disorders
* Vasculitides
* Prolonged vasoconstrictors

== History/exam ==

* Thorough history - look for vascular risk factors
* Exam - all pulses/bruits
* Try to distinguish between causes of gangrene - atheroembolisation vs occlusive disease
* ABI
* Toe pressures

== Imaging ==

* Start with USS doppler
* CTA

== Amputations ==

* If confined to tip of toe, partial toe amputation, preserving proximal phalanx
* Try to preserve first metatarsal head - important for gait/balance
* If forefoot gangrene, or multiple toe involvement, need to do transmetatarsal amputation
* If entire foot and heel involved, need to do leg

[[Category:Vascular]]