Gangrene

Background

Gangrene is a form of necrosis characterized by both liquefactive and coagulative necrosis. It is more a clinical diagnosis rather than a true pattern of cell death. Most commonly, it occurs on a limb which has lost its blood supply and undergoes coagulative necrosis. Sometimes, the tissue changes lead to dessication and mummification, and this gangrene is termed dry gangrene. If a bacterial superinfection occurs, liquefactive necrosis supervenes causing a wet gangrene.

CLINICAL APPEARANCE/GROSS DISEASE VARIANTS CHARACTERIZATION

Progressive ischemic gangrene in dialysis patients: a clinicopathological correlation.

el-Reshaid K, Madda JP, al-Duwairi Q, Sugathan T.

Department of Medicine, Faculty of Medicine, Safat, Kuwait.

Ren Fail 1995 Jul;17(4):437-47 Abstract quote

The syndrome of progressive ischemic gangrene (PIG) of the extremities was examined over 3.5 years in patients undergoing maintenance dialysis (MD) in Kuwait and was compared to that in a similar age group (> 40 years) in the general population.

The incidence of PIG in MD patients was 15.4/1000 person years of observation (PYO) versus 0.086/1000 PYO in the general population. Patients with diabetes mellitus were found to be at particular risk. PIG developed in 41.4/1000 PYO of diabetic patients who received MD, compared to 7.1/1000 in nondiabetic patients on MD and 0.14/1000 in diabetics without renal disease. The clinical, biochemical, radiological, and histological findings in the 8 patients who developed PIG while on maintenance dialysis (MD) are presented. Two patients had severe hyperparathyroidism and their histological findings were consistent with systemic calciphylaxis. Histological examination, in the remaining patients, showed severe calcified atherosclerosis. Intimal hypertrophy was common especially in patients with long duration on dialysis. The three lesions produced a variable degree of luminal narrowing and were associated with arterial thrombosis. None of the patients showed evidence of iron deposition even in those with systemic calciphylaxis and excessive iron stores.

Our study indicated a high incidence of PIG in patients undergoing MD, especially in those with diabetes mellitus. These findings constitute a cogent argument in favor of early parathyroidectomy in selected cases and concern with long-term consequences of atherosclerosis in this patient population.

Sternberg S. Diagnostic Surgical Pathology. Third Edition. Lipincott Williams and Wilkins 1999.

Commonly Used Terms

AKA-Above the knee amputation

BKA-Below the knee amputation

Internet Links

Last Updated 4/1/2001