Ischemic necrosis and gangrene
Ischemic necrosis and gangrene of the fingers which became black and malodorous!! This patient received a diagnosis of ischemic dry gangrene, most likely due to critically insufficient blood supply secondary to severe atherosclerotic peripheral arterial disease. He declined to undergo further investigation or surgical management, citing the expense and the possibility of complications. The patient instead elected conservative treatment with analgesia, an antiplatelet agent, and management of his vascular risk factors. There are several types of gangrenes. Dry gangrene happens due to insufficient blood flow to the tissue, typically from atherosclerosis. Wet gangrene involves bacterial infection, usually with skin flora. The third type, gas gangrene, is due to Clostridium perfingens infection. The limited oxygen in the ischemic limb limits putrefaction and bacteria fail to survive. The affected part is dry, shrunken and dark reddish-black. The line of separation usually brings about complete separation, with eventual falling off of the gangrenous tissue if it is not removed surgically, a process called autoamputation. Dry gangrene is the end result of chronic ischemia without infection. Diabetes for example damages blood vessels, restricting or compromising the blood supply to the hands and feet, tissues are deprived of oxygen, thus causing the cells to die. If ischemia is detected early, when ischemic wounds rather than gangrene are present, the process can be treated by revascularization (via vascular bypass or angioplasty). However, once gangrene has developed, the affected tissues are not salvageable. Because dry gangrene is not accompanied by infection, it is not as emergent as gas gangrene or wet gangrene, both of which have a risk of sepsis.
