typically lcated at the termination of arterial branches. They are commonly found on the tips of the toes and between the digits. They can also form at increased focal pressure, such as lateral malleolus and metatarsal heads. In addition to ulcers, patient can present a gangrenous digit or foot. Gangrene can either be dry or wet. Dry gangrene is characterized by a hard, dry texture, often with a clear demarcation between viable and black, necrotic tissue. This form of gangrene is common in patients with PAD. Wet gangrene is characterized by its moist appearance, gross swelling, and blistering. Wet gangrene is a surgical emergency. Pt presented in the ED with wet gangrene, and dry gangrene post op.
(Neschis, 2016)
Ischemia sufficient to threaten a limb occurs when arterial blood flow is insufficient to meet the metabolic demands of resting muscle or tissue. Once patient’s body is unable to maintain the metabolic needs, it goes into anaerobic metabolism, which is seen in labs as high lactic acid. Acute thrombosis of sites of stenosis in which the blood flow impairment was hemodynamically significant can occur and present with acute symptoms., such as pain, pallor, paresthesias, paralysis, pulselessness, and poikilothermia(coldness). Symptoms of parethesias and paralysis may indicate advanced ischemia that is affecting nerve pathways of the extremity. Patient had ischemic ulcer in L foot, and signs of parethesias, pulselessness, and pain.
(Baird, 2016 p590, Porth, 2011 p415)
The presence of ischemia from occlusion to a lower extremity influences the timing of revascularization, debridement, and definitive coverage/closure. Wounds will not be able to heal as well as a result of ischemia and may lead to necrotizing of the soft tissue. It may come in the form of cellulitis, myositis, and fasciitis.
Necrotizing cellulitis include anaerobic infection and Meleny’s syngergistic gangrene. Anaerobic cellulitis can be divided into clostridial anaerobic cellulitis and non-clostridial anaerobic cellulitis. Clostridial anaerobic cellulitis is usually caused by C. perfringens. These organisms may be introduced into the subcut