Gangrene

Approach

  • Expose limb
  1. Inspection

    • Appearance of gangrene, check between toes
    • Wet (complicated by infection) / dry
    • Skin blistering
    • Line of demarcation between healthy and dead tissue
  2. Palpation
    • Peripheral pulses
    • Check temperature differences
  3. Percussion
  4. Auscultation

Causes of gangrene

Irreversible tissue necrosis due to

  1. DM
  2. Emboli / thrombi: mesenteric infarction giving rise to "trash foot"
  3. Raynauld's
  4. Buerger's disease
  5. Ergot poisioning
  6. Vessel injury

Fournier's gangrene

  1. Rare necrotising subcutaneous infection involving scrotum, penis and perineum
  2. Scrotum red and swollen with crepitus on palpation due to dermal gangrene
  3. Organisms responsible - coliforms and anaerobes (clostrium)