Causes of necrosis

Necrosis can be due to infection, when it is usually wet, or to occlusive macrovascular disease of the arteries of the leg, when it is usually dry. Necrosis is not, as previously thought, due to a microangiopathic arteriolar occlusive disease, or so-called small vessel disease. Health-care professionals working with diabetic foot disease should avoid using this term, which is imprecise and may lead to therapeutic nihilism.

Digital necrosis is common in patients with renal impairment, particularly those with end-stage renal failure, even though they are treated with dialysis. Patients with severe renal impairment also have a propensity to develop dry necrosis, sometimes in the presence of palpable pedal pulses and in the absence of infection. A further discussion of foot disease in the diabetic patient with renal impairment is given below.

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