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Department
of Podiatry - Vascular Assessment
Gangrene
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.
Gangrenous
toes (dry).
Gangrenous
hallux (dry).
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