Limb Ulceration + Gangrene Flashcards
1
Q
What is gangrene?
A
Death of tissue from poor vascular supply, a sign of critical ischaemia
2
Q
What is dry gangrene?
A
- Necrosis in absence of infection
- Linear demarcation between living + dead tissue
3
Q
What is the management of dry gangrene?
A
Restoration of blood supply +/- amputation
4
Q
What is wet gangrene?
A
Tissue death and infection
5
Q
What is the management of wet gangrene?
A
- Analgesia
- Broad spectrum antibiotics
- Surgical debridement +/- amputation
6
Q
What is gas gangrene and risk factors??
A
- Subset of necrotising fascitis
- Caused by spore-forming clostridial species
- Rapid onset of myonecrosis, muscle swelling, gas production, sepsis + severe pain
- RFs → DM, trauma, malignancy
7
Q
What is the management of gas gangrene?
A
- Remove dead tissue eg. amputation
- Benzylpenicillin +/- clindamycin
- Hyperbaric O2 can reduce number of debridements
8
Q
What are features of necrotising fascitis?
A
- Rapid progressive infection of deep fascia causing necrosis of subcut tissue
- Usually by Group A B-haemolytic strep, but mostly polymicrobial
- Sx → intense pain of skin and underlying muscle
9
Q
What is the management of necrotising fascitis?
A
- Radical debridement +/- amputation
- IV Abx eg. benzylpenicillin + clindamycin
10
Q
What are differentials for shin lesions?
A
- Erythema nodosum → symmetrical, erythematous, tender, heal without scarring; caused by strep, sarcoidosis, IBD, drugs (pencillins, sulphonamiddes, OCP)
- Pretibial myxoedema → symmetrical, erythematous lesions, Graves’; shiny orange peel skil
- Pyoderma gangrenosum → initially small red papule, later deep red necrotic ulcers, violaceous border, 50% idiopathic, also seen in IBD, connective tissue disorders
- Necrobiosis lipoidica diabeticorum → shiny, painless areas of yellow/red skin on shin in diabetics, associated w/ telangiectasia
11
Q
What are features of pyoderma gangrenosum?
A
- Typically on lower limbs
- Initially → small red papule
- Later → deep red necrotic ulcers + violaceous border
- +/- fever & myalgia
12
Q
What are causes of pyoderma gangrenosum?
A
- Idiopathic (50%)
- IBD: UC + Crohn’s
- Rheumatoid arthritis, SLE
- Myeloproliferative disorders
- Lymphoma, myeloid leukaemias
- Primary biliary cirrhosis
- Monoclonal gammopathy (IgA)
13
Q
What is the management of pyoderma gangrenosum?
A
- Potential for rapid progression is high in most pts
- Most drs advocate oral steroids as first-line treatment
- Other immunosuppressive therapy, eg. ciclosporin + infliximab have a role in difficult cases