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Environmental Injuries
Published in Ayşe Serap Karadağ, Lawrence Charles Parish, Jordan V. Wang, Roxburgh's Common Skin Diseases, 2022
Soo Jung Kim, Alexander V. Nguyen
Clinical presentation: Affected areas are well-demarcated and appear blanched and white before progressing to a darker or purplish hue. During rewarming, edema, blisters, and in severe cases, gangrene can appear. The severity is related to both the temperature and duration of exposure.
Other Complications of Diabetes
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Gangrene is a condition involving tissue death and decay (see Figure 13.3). It is caused by lost blood supplies or by bacterial infections. Removing dead tissue – often by amputation – as well as with antibiotics, usually treats it. There are three different types of gangrene: ∎ Dry gangrene – From lost blood supply to affected tissues∎ Wet gangrene – From bacterial infections, or in diabetics, a complication of foot ulcers∎ Gas gangrene – Usually caused by Clostridium perfringens, a bacterium that produces gas and toxins
Diabetes
Published in Sally Robinson, Priorities for Health Promotion and Public Health, 2021
Peripheral arterial disease means that any small abrasion or cut in the toes or foot may become a bigger wound as it fails to heal and may become infected. Any unusual signs in the feet, including being cold, numb, swollen or aching, require immediate medical attention. Surgery, in some cases amputation, is recommended to prevent gangrene spreading throughout the body and causing death. A person with diabetes is 20 times more likely to need an amputation compared to other people (Diabetes UK, 2020c). For example, in Scotland 1,401 people with diabetes had a major lower limb amputation in 2018, which represented 0.5% of all people with diabetes (Scottish diabetes data group, 2019). In England 2015/16 to 2017/18, there were 7,545 similar amputations, which can be standardised to 8.2 per 10,000 population-years (Figure 15.7).
Effect of leukocyte-platelet fibrin-rich wound reconstruction followed by full-thickness skin grafting in the treatment of diabetic foot Wagner grade 4 ulcer gangrene (toe area)
Published in Platelets, 2023
Yuqi Wang, Yanyan Wang, Xiaotao Wang, Yi Zhao, Siyuan Ruan, Hong Cao
Diabetic foot is one of the most serious complications of diabetes and the leading cause of nontraumatic amputation. According to statistics, the total incidence of diabetic foot ulcers in the world is approximately 6.3%, and approximately 25% of patients have ulcer wounds that will not heal for the rest of their lives. At the same time, the probability of ulcer recurrence after ulcer healing is as high as 60%, and the extremely high recurrence rate of ulcers also increases the risk of amputation [1,2]. The gradual subsidence of limb sensation also makes the affected limb vulnerable to trauma but unable to be treated in time, which aggravates foot ulcers; such trauma includes friction from shoes, impact and crushing from objects, scalding, and even burns, which especially affect the toes of the diabetic foot [3,4]. In the most commonly used Wagner classification of diabetic foot ulcers, localized gangrene of the toes, heels or dorsum of the forefoot (grade 4) is second only to gangrene of the affected limb (grade 5) and is an extremely difficult wound to manage. The appearance of localized gangrene marks the destruction of the local blood supply and irreversible necrosis of soft tissue structures, often accompanied by local infection and soft tissue defects (mostly combined with trauma). If not handled properly, this condition can easily develop into larger areas of ulcers and gangrene and eventually lead to amputation (e.g., toe amputation) [1,5].
Human vulnerability and variability in the cold: Establishing individual risks for cold weather injuries
Published in Temperature, 2022
François Haman, Sara C. S. Souza, John W. Castellani, Maria-P. Dupuis, Karl E. Friedl, Wendy Sullivan-Kwantes, Boris R. M. Kingma
While the damage caused by NFCI is harder to determine, FCI can cause lasting damage to affected tissues. In severe cases, amputation of gangrene is necessary to prevent the spread of rapidly dying tissue. Of the surviving tissue, there are often symptoms of neuropathy and damaged vasoconstriction responses that may lead to reduced ability to counteract cold environments [182–184]. When examining elite alpinists with previously injured tissue, including some amputations, cold water immersion of the previously injured hand felt significantly colder compared to the uninjured hand [185]. Although there were no differences in rewarming rate between previously injured and healthy tissue, hands with previously injured tissue were consistently lower Tskin throughout rewarming [182,185]. To reduce the risk of further cold injuries, repeating local cooling to the extremities can improve tissue perfusion, assuming no injury to the tissue during local acclimation [186–188].
Asymptomatic coronary aneurysms in a patient with eosinophilic granulomatosis with polyangiitis who developed a digital gangrene
Published in Modern Rheumatology Case Reports, 2021
Mayu Sato, Yusuke Yoshida, Tomohiro Sugimoto, Shinji Kishimoto, Takuji Omoto, Hirofumi Watanabe, Tadahiro Tokunaga, Kazutoshi Yukawa, Hiroki Kohno, Sho Mokuda, Takaki Nojima, Shintaro Hirata, Eiji Sugiyama
Digital gangrene is a severe ischaemic complication due to vasculopathies or vasculitides. Systemic sclerosis (SSc) and antiphospholipid syndrome (APS) are famous as the underlying causes of digital gangrene due to vasculopathies. [21,22] In this aetiology, structural changes in arterioles and microvasculopathies can be detected from nailfold capillaries. [23] Although our case showed Raynaud’s phenomenon and severe peripheral circulatory disturbance, abnormalities found in SSc or APS were not detected on NVC. The findings of nailfold capillaries might help in the differential diagnosis of severe ischaemic involvements by excluding SSc or APS. On the other hand, rheumatoid vasculitis (RV) and polyarteritis nodosa (PAN) are also famous as the underlying causes of digital gangrene due to vasculitides. It may be difficult to distinguish EGPA from other systemic vasculitides by using NVC because few studies have evaluated the nailfold abnormalities in systemic vasculitis. [24] However, our case did not have RV because he had no arthritis. Moreover, he was classified as EGPA according to classification algorithm published by American College of Rheumatology, which enabled a diagnosis of AAV or PAN without pathological evidence. [3,25]