Bilateral upper limb digital gangrene in a patient on maintenance hemodialysis

Upper limb gangrene is uncommon compared to lower limb gangrene. But digital gangrene is seen occasionally in patients on maintenance hemodialysis. Of the various causes described, atherosclerosis, diabetic vascular disease, following AV fistula surgery were few of the causes. Herein, we report a case of development of early digital gangrene following AV fistula in a patient on maintenance hemodialysis.     

Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria‐induced disseminated intravascular coagulopathy

Ghafoor SZA, MacRae EA, Harding KG, Patel GK. Symmetrical peripheral digital gangrene following severe Plasmodium falciparum malaria‐induced disseminated intravascular coagulopathy. Symmetrical peripheral digital gangrene is a life‐changing complication, caused by a pro‐thrombotic life‐threatening disease, such as disseminated intravascular coagulopathy (DIC) secondary to systemic infection. We describe the unusual case of a woman who developed symmetrical peripheral digital gangrene following DIC because of malaria. While initial treatment led to cure of the infection, in this report we describe also the subsequent management of symmetrical peripheral digital gangrene.     

Conservative debridement of postoperative Meleney's gangrene following a caesarean section

Meleney's gangrene is almost exclusively postoperative and is caused by multiple bacteria. This case review describes the conservative management of Meleney's gangrene in a young patient following a Caesarean section.     

A Fournier's gangrene after transurethral resection of the prostate

Fournier's gangrene is a rapidly progressive and potentially lethal disease that affects the perineum and mal genitalia. Predisposing factors included age, diabetes, alcoholism, malnutrition, and low socio-economic status. Herein, we present a 70-year-old patient who developed Fournier's gangrene following transurethral resection of the prostate. He had no predispositional factors to develop Fournier's gangrene.     

A Fournier’s gangrene after transurethral resection of the prostate

Fournier’s gangrene is a rapidly progressive and potentially lethal disease that affects the perineum and male genitalia. Predisposing factors included age, diabetes, alcoholism, malnutrition, and low socio-economic status. Herein, we present a 70-year-old patient who developed Fournier’s gangrene following transurethral resection of the prostate. He had no predispositional factors to develop Fournier’s gangrene.     

Bilateral gas gangrene of the hand - a unique case

Gas gangrene is a rare and rapidly progressive process with the propensity for devastating consequences. We report the first case of bilateral gas gangrene of the hand following bilateral middle phalangectomy of the middle fingers.     

Clostridial gas gangrene complicating Colles' fracture

We present a case of Clostridial gas gangrene following closed reduction of a Colles' fracture. A review of the laboratory and clinical literature on treatment of gas gangrene revealed wide differences of opinion regarding the effectiveness of surgery, antibiotics, antitoxin and especially hyperbaric oxygen. We found no previous report of clostridial gas gangrene in closed reduction of a Colles' fracture. The survival rates for 28 cases of Clostridial myonecrosis treated at Vancouver General Hospital with surgery, antibiotics and hyperbaric oxygen were 100% for extremity gangrene and 65% for trunk gangrene. We conclude: Gas gangrene is rare, but can complicate even minor trauma or procedures performed in hospital. Prevention depends on proper debridement of wounds and open fractures. Compartment syndromes may be important as etiologic and complicating factors. Hyperbaric oxygen may have therapeutic value but its use has not improved on survival rates achieved during World War II with surgery and antibiotics alone.     

Fournier's gangrene following penile self-injection with cocaine

To date, there have been no reports of Fournier's gangrene following penile self-injection of cocaine. We report a case of cocaine-induced Fournier's gangrene requiring parenteral antibiotics followed by primary surgical debridement and delayed reconstructive procedure of penile skin.     

Breast gangrene as a complication of puerperal sepsis

Gangrene of the breast, although rare, has been reported following anticoagulant treatment, trauma, and infection. Two cases of breast gangrene due to puerperal sepsis have been reported. We report a case of right breast gangrene as a complication of puerperal sepsis in a female patient.     

Idiopathic purpura fulminans and varicella gangrenosa of both hands, toes and integument in a child.

Chicken pox is a common childhood illness and, though a vaccine is readily available, it is not routinely included in the vaccination schedule of most countries owing to its mild clinical nature. However, varicella gangrenosa is a rare complication of this disease, infrequently reported in the literature. We report the case of a child who developed purpura fulminans in the convalescent phase of chicken pox and subsequently presented with peripheral gangrene of both hands and the toes of the right foot, and skin gangrene. To our knowledge, bilateral gangrene of the hands has rarely been reported, and we present this case to highlight the serious nature of complications following varicella infection.     

Necrotizing infection due to Bacillus cereus mimicking gas gangrene following penetrating trauma

An 8-year-old boy presented with fulminant necrotizing infection resembling gas gangrene following penetrating trauma from a tree branch. Bacillus cereus was isolated from tissue specimens, showing that unexpected pathogens can be isolated. It is essential to submit specimens for culture, as this organism is typically resistant to beta-lactam antibiotics and metronidazole, the empiric choice for gas gangrene.     

Simultaneous ligation of vein in ligation of large arteries: Experimental study

Consideration of the problem of simultaneous ligation of the companion vein when it is necessary to ligate a large artery has led to a review of the clinical and experimental literature and the presentation of our own experimental results. Review of the clinical literature leads us to believe that: (1) Most surgeons consider the incidence of gangrene of a limb following ligation of its main artery to be very high. Halsted did not concur in this view and made an elaborate analysis of all reported cases to prove his stand. Our own experience with dogs indicates that the incidence of gangrene in this animal following the uncomplicated ligation of the external iliac artery is rare. (2) Previous to 1916 every effort was made to preserve the accompanying vein in the belief that its occlusion increased the danger of gangrene. Since 1916 and the experience gained in the World War, this policy has completely changed, and many surgeons advocate the simultaneous occlusion of the accompanying vein when an artery is ligated to prevent gangrene and to aid in the establishment of collateral circulation. There are some discrepancies in the clinical statistics on which the advocacy of this procedure is based. We have already considered the experimental data with which various authors attempt to establish the procedure on a sound physiological basis. In the light of our experiments here presented, and the previous experiments of Harvey and Ferris³³ in 1925, the earlier temperature experiments of Brooks and Martin³⁰ would seem to have been of too short duration to give an adequate idea of the effect of simultaneous vein ligation. Their experimental results on the incidence of gangrene in rabbits, however, are not disproved. On the other hand, Brooks³⁶ has questioned the conclusions of Holman and Edwards³⁴ based on the increased flow of blood from the distal end of the divided femoral artery, and we agree with him in this. Again, Holman and Edwards' comparison of their results on the incidence of gangrene in rabbits with those of Brooks and Martin is not conclusive because of differences in the methods of ligation. The contradictory results of Pearse³⁷ and Theis³⁸ in regard to roentgen findings after ligation and injection will need further rechecking. So it would seem that the experimental literature does not provide any sound physiological proof that the procedure of simultaneous ligation of the accompanying vein either decreases the incidence of gangrene or aids in the establishment of collateral circulation when a large artery is ligated.Our previously reported experiments¹ on establishment of the collateral circulation in the dog, lead us to believe that the incidence of gangrene following the ligation of the external iliac artery, at least in this animal, is small. Consideration of the statistics from reported cases in the literature from 1900 to 1930 of ligations of the iliac and femoral arteries strengthens the opinion that the incidence of gangrene in the human following the uncomplicated ligation of these vessels either with or without ligation of the companion vein is smaller than generally supposed.Finally the results of our experiments here reported indicate that in seven dogs, the temperature curve showing the return of collateral circulation was no different whether or not the accompanying vein was ligated with the artery. Furthermore, there was no gangrene in either leg of any of these dogs.     

LOCAL COMPLICATIONS OF THIOPENTONE INJECTION

Cases of local complications following injection of thiopentonethat had been reported to the Medical Defence Union over a recentseven-year period were investigated. There were three casesof gangrene distal to the site of injection; five cases of isolateddamage to nerves and muscles; ten cases of local tissue necrosisat the site of injection. It is estimated that the incidenceof gangrene is probably less than one case in a million injections.Brief case reports are presented.     

St. Anthony's fire: successful reversal of ergotamine-induced peripheral vasospasm by hydrostatic dilatation

A 60-year-old trauma victim developed severe ischemia of all four extremities following administration of heparin-dihydroergotamine as prophylaxis against deep venous thrombosis. Despite cessation of heparin-dihydroergotamine and infusion of intraarterial papaverine into the right femoral artery, both lower extremities progressed to frank gangrene and amputation (above-knee on the left and below-knee on the right). However, both ischemic upper extremities were salvaged following intraoperative hydrostatic dilatation with balloon catheters. Ergotism is an avoidable and potentially treatable cause of peripheral gangrene in the critically-ill patient.     

Wound infection after lower extremity amputation because of ischemia

The importance of postoperative wound infection in major amputations was elucidated by recording the organisms isolated in preoperatively infected gangrene and in postoperatively infected wounds of patients undergoing lower-limb amputations for ischemia. Sixty-four amputations were performed on 61 patients. The frequency of coexisting diabetes mellitus was 34%. Postoperative infections occurred in nearly two-thirds of the 19 cases of infected gangrene, as compared with less than one-third of cases of noninfected gangrene. The presence of diabetes mellitus did not significantly influence the infection rate. Preoperatively as well as postoperatively, the most frequently isolated bacterium was Staphylococcus aureus. Clostridium perfringens was cultured in four cases. Postoperative wound infection following lower-limb amputation for ischemia is the main reason for reamputation, especially in patients with infected gangrene.     

Fournier's gangrene: a complication of penile prosthetic implantation in a renal transplant patient

The management of erectile impotence in renal transplant patients remains problematical. The enhanced risk of surgical infection in this immunosuppressed patient population must be addressed if prosthetic implantation is contemplated. A case of Fournier's gangrene (synergistic necrotizing gangrene of the genitalia) following implantation of a Small-Carrion penile prosthesis is reported. This potentially life-threatening infection demonstrates graphically the surgical infection risk of this population and suggests extreme caution before proceeding with a prosthetic operation in this unique subset of impotent patients.     

Hyperparathyroidism presenting as an unusual cause of lower extremity gangrene

Vascular surgeons are often consulted on the management of lower extremity ulcerations and gangrene which are commonly due to atherosclerotic arterial occlusive disease or to chronic venous insufficiency. The following report describes an unusual case of severe lower extremity cutaneous gangrene associated with secondary hyperparathyroidism and a review of the literature.     

Scrotal reconstruction in Fournier syndrome.

The extent of the scrotal defect following debridement of Fournier gangrene ranges from relatively small areas of scrotal loss to complete denudation of the testes and cords. In our experience, denudation of the testis alone is best treated by split-thickness mesh grafts and total denudation of the testis and cord by burial of the testicle in a subcutaneous medial thigh pocket. Three cases are presented illustrating the spectrum of methods that can be used either singly or in combination to repair scrotal defects in Fournier gangrene.     

Gangrene and renal failure caused by dihydroergotamine used to treat raised intracranial pressure following head trauma

A case of peripheral gangrene and renal failure following the use of dihydroergotamine (DHE) for treatment of raised intracranial pressure (ICP) is reported. There have been several reports of vasospasm and peripheral gangrene caused by DHE used in combination with heparin for prevention of deep venous thrombosis. Clinical experience with the use of DHE in head trauma is limited. This case report emphasises the seriousness of the adverse effects associated with the use of this drug.