Gangrene Pictures

Figure 7.22 Digital subtraction angiography of the foot shown in Figure 7.21. Multifocal atheromatous lesions of both iliac and superficial femoral arteries and increased development of collateral vessels can be seen. This pattern of arterial obstruction is considered typical in diabetes. (Courtesy of E. Bastounis)

admission; the pain worsened progressively and had become refractory to analgesics in the last 2 days. He denied any trauma to his feet. The patient had fever (38.7 °C) with rigors and tachycardia; his hemoglobin level was 10 g/l and his white blood cell count was 16,000/l.

Wet Gangrene
Figure 7.23 Wet gangrene of the right foot. Redness and edema due to infection extends as far as the lower third of the tibia. (Courtesy of E. Bastounis)
Gangrene Feet
Figure 7.24 Wet gangrene of midfoot and forefoot in addition to an infected necrotic ulcer on the outer aspect of the dorsum. (Courtesy of E. Bastounis)
Gangrene Infection Pictures

Figure 7.25 An infected ulcer under the base of the fifth toe of the patient whose foot is shown in Figure 7.24, probably the portal for pathogens. Gangrene of second toe and mild callus formation under the third metatarsal head can also be seen. (Courtesy of E. Bastounis)

Figure 7.26 Wet gangrene involving the forefoot with cellulitis extending as far as the right ankle. The bone and articular surfaces of the interphalangeal joint of the fourth toe are exposed. Congenital overriding fifth toe and ulceration under the fifth metatarsal is apparent together with onychodystrophy and ingrown nail of hallux. (Courtesy of E. Bastounis)

Figure 7.26 Wet gangrene involving the forefoot with cellulitis extending as far as the right ankle. The bone and articular surfaces of the interphalangeal joint of the fourth toe are exposed. Congenital overriding fifth toe and ulceration under the fifth metatarsal is apparent together with onychodystrophy and ingrown nail of hallux. (Courtesy of E. Bastounis)

Severe Onychodystrophy

On examination, he had wet gangrene involving the right forefoot, with cellulitis extending as far as the right ankle (Figure 7.26). The bone and articular surfaces of the interphalangeal joint of the fourth toe were exposed. Ruptured blisters were observed under the right sole (Figure 7.27). The patient was treated with i.v. antibiotics (piperacillin-sulbactam plus metronidazole) while extensive surgical debridement of the necrotic tissue and drainage of the abscess cavities was carried out. Staphylococcus aureus, Escherichia coli and anaerobic cocci were isolated from a deep tissue culture. An angiograph revealed multilevel atheromatous stenosis of his common femoral, superficial femoral, popliteal and tibial arteries.

The patient had his second and third toes amputated. Extensive longitudinal incisions in the dorsum and the lateral foot were undertaken. Within 2 days his condition worsened rapidly, and he sustained an amputation below his right knee.

Wet gangrene is characterized by a moist appearance, gross swelling and blistering. This is an emergency situation which occurs in patients with severe ischemia who sustain an unrecognized trauma to their toe or foot. Urgent debridement of all affected tissues and use of antibiotics often results in healing if sufficient viable tissue is present to maintain a functional foot together with adequate circulation. If wet gangrene involves an extensive part of the foot, urgent guillotine amputation at a

Gangrene Sole Foot
Figure 7.27 Sole of the foot shown in Figure 7.26 with wet gangrene of the forefoot, ulceration under fifth metatarsal head and ruptured blisters. (Courtesy of E. Bastounis)

level proximal enough to encompass the necrosis and gross infection, may be life saving. At the same time a bypass surgery or a percutaneous transluminal angioplasty should be performed when feasible. Saline gauze dressings, changed every 8 h, work well in open amputations. Revision to a below-knee amputation may be considered 3 - 5 days later.

Keywords: Wet gangrene; deep tissue infection; onychocryptosis; ingrown nail

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Responses

  • Jessica
    Can diabetic ulcers be located on lateral aspect of foot?
    7 years ago

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