Dry Gangrene of Extremities - Contents | Cases | Comments | Bibliography

Dry Gangrene of Extremities

Comments

Although usually present, fever need not always be present- the host response may simply be overwhelmed. I agree that the "picture" may not be classic, but the treatment (unfortunately) remains the same - medical supportive care & wait for tissue demarcation to guide your final amputation levels.

Charles T Mehlman, DO
Division of Pediatric Orthopaedic Surgery
Children's Hospitla Medical Center
Cincinnati, Ohio [USA]

Jacobsen ST, Crawford AH. Amputation Following Meningococcemia: A Sequelae to Purpura Fulminans. Clin Orthop Rel Res 185:214-219, 1984.

Dabney KW, Bowen JR. Complications of Musculoskeletal Infections. Chapter 32 In: CH Epps & JR Bowen [eds] Complications in Pediatric Orthopaecic Surgery. JB Lippincott. Philadelphia. 1995.

Saez-Llorens X, Lagrutta F. The Acute Phase Host Reaction During Bacterial Infection and its Clinical Imapct in Children. Pediatr Infect Dis J 12:83-87, 1993.

Styrt B, Sugarman B. Antipyresis and Fever. Arch Int Med 150:1589-1597, 1990.

richard strain (Tue 14 Apr 1998 - 13:03:27 BST)
I had one case in a healthy 27 year old female that developed Acute Gangrene of 4 limbs after significant weight loss and she was on a number of "healthfood" supplements we never found the cause even at post mortem.
Rick Strain

Iain Thirsk (Tue 14 Apr 1998 - 20:53:36 BST)
we have seen this not infrequently in very young children following severe dehydration caused by diarrhoea and vomiting. I'm not sure what "a desert journey" involves and how well the child was cared for and watched. Our
patients come with all sorts of weird and wonderful histories which do more to cloud issues than help. We do see a lot of venomous bites mainly from snakes (about 250 admissions per year) and they do not present like this, but such things tend to be very regional. The chances are if something venomous did do that to a child you would know about it locally.
I think the advice already given was good - treat supportively and allow the extremities to demarcate before attempting debridement, and then just do the minimum.
Iain Thirsk it@pixie.co.za
Surgeon, Ngwelezana Hospital, Kwa Zulu Natal, South Africa
 
Albert B. Accettola Jr. MD (Wed 15 Apr 1998 - 03:39:00 BST)
Could it be a Protein-C defficiency, with the hypercoagulable state being brought on by relative dehydration?
Albert B. Accettola Jr. MD

Wosk (Wed 15 Apr 1998 - 05:44:23 BST) wosk@internet-zahav.net
I know about same features that happen in small children in M. East deserts, but never saw so spreaded multifocal gangrenas. The reason of lesion is cold injury. Usually malnutrition and some degree of dehydration are predisposing factors. Children have been exposured for low temperature in local tribes tents. The problem is in desert the great fluctuation of high midday temperatures that drops sharply to very low night temperatures.
I believe, you just have very good advices from some fellows of the list. I am only worry about thigh injury. This is location where dry gangrena can perform to wet with sepsis etc.I think that antibiotic administration, hyperalimentation and closed supervision are avaiable.

Ahmad Bo-eisa (Wed 15 Apr 1998 - 16:24:20 BST) (Originator)
Yes the desert at this time of the year is very cold at night. We never see this type of ischemic gangrene even if the child is left uncovered. The patient has somehow a pregressive gangrene during the daytime when the family have noticed that upper limbs started first. His general condition remains stable. His coagulation profile was in a reasonable status with a moderately high platelet's count.

Ahmad Bo-eisa (Wed 15 Apr 1998 - 15:44:09 BST) (Originator)
Thank you. I started to believe that is is in favor of PURPURA FULMINANS. Now it is 3 weeks since the onset. The patient is otherwise in good stable condition. demarkation is well established now and he is ready for amputations.

COBDEN (Thu 16 Apr 1998 - 08:40:58 BST)
Have seen this once before, in a young man with a history of splenectomy and subsequent pneumococcal infection and sepsis.  COBDEN@aol.com