Sample Solution

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 subcutaneous tissue via trauma, surgical contamination, or spread of infection from the bowel to the perineum, abdominal wall, or lower extremities. The presence of foreign debris and necrotic tissue in a wound provides an appropriate environment for the proliferation of clostridial cells. Nonclostridial anaerobic cellulitis is caused by various non-spore-forming anaerobic bacteria(Bacterioides specis, peptostreptococci, and others) either alone of mixed with facultative organisms such as coliform bacilli, streptococci, staphylococci. Meleney’s synergistic gangrene is a rare infection that occurs in post-operative patient. It’s characteristic is a slowly expanding ulceration that is confined to the superficial fascia and results from a synergistic interaction between S. aureus and microaerophillic streptococci.
Necrotizing myositis, also known as spontaneous gangrenous myositis is relatively rare. It is a necrotizing infection of skeletal muscle caused by group A Streptococcus or other beta-hemolytic streptococci. It may be preceded with skin abrasions or blunt trauma. The infection will progress over several hours and involve muscle groups and soft tissue. If the patient develops streptococcal toxic shock syndrome, t