Symmetrical Peripheral Gangrene and Disseminated Intravascular Coagulation

Molos, Mark A.; Hall, John C.

doi:10.1001/archderm.1985.01660080111027

Cited by 100 publications

(68 citation statements)

References 38 publications

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“…A review of the literature concerning patients with symmetrical peripheral gangrene reported a mortality rate of 35%. 10 Lifesaving attempts are made in all cases managed in intensive care units. In addition to intensive supportive treatment, drug intervention, including administration of corticosteroids, anticoagulants, antiplatelet drugs, and activated protein C (drotrecogin alfa) to stabilize disseminated intravascular coagulation, is indicated.…”

Section: Discussionmentioning

confidence: 99%

Limb fitting for quadruple amputees

Yoshimoto¹,

Okuma²,

Nakamura³

et al. 2013

Prosthetics &Amp; Orthotics International

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Background: We report our experiences of prosthetic fitting in quadruple amputees. Two patients underwent quadruple amputation after suffering from disseminated intravascular coagulation in conjunction with pneumococcemia with purpura fulminans. Case Description and Methods: The first patient, a 52-year-old man, underwent bilateral transradial, left transtibial, and right transfemoral amputation, and the second patient, a 62-year-old man, underwent bilateral transradial and bilateral transfemoral amputation, both for symmetrical peripheral gangrene subsequent to septic shock. Findings and Outcomes: The amputations were accompanied by skin damage due to ischemic tissue changes both on the stumps and on the nose and/or lips. The combination of the intensive prosthetic rehabilitation program and supportive medical care led to completely independent functioning, including driving a car, with the use of four prosthetic limbs and a wheelchair in both cases. Conclusion: Early initiation of a multidisciplinary approach can properly address impairments and minimize future disability. Clinical relevanceWe have reported our experience of limb fitting in two patients who had undergone quadruple amputation after suffering peripheral gangrene. Appropriate limb fitting that provides support in daily activities can address impairments and minimize disability.

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Section: Discussionmentioning

confidence: 99%

Limb fitting for quadruple amputees

Yoshimoto¹,

Okuma²,

Nakamura³

et al. 2013

Prosthetics &Amp; Orthotics International

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“…Symmetrical peripheral gangrene is described as multiple extremity ischemia at two or more sites in the absence of large vessel obstruction [1,2]. Possible etiological factors cited in literature include obstructive intracardiac lesions [3], sepsis [4], vasospastic conditions [5,6], small vessel obstruction [1], protein C deficiency [7], use of vasopressor agents [8,9], low cardiac output states [10,11], disseminated intravascular coagulation (DIC) [12,13], factor V Leiden mutation [14], and parenteral abuse of the sublingually available form of buprenorphine [15]. It is well established that the digital perfusion will drop to zero in presence of persistently low perfusion pressures of 35-60 mmHg [16].…”

Section: Discussionmentioning

confidence: 99%

“…Vigorous therapy of sepsis with intravenous antibiotics and anticoagulation for DIC are the other suggested measures [4,12]. Sympathetic blockade, intravenous vasodilators, local injection of alpha-blockers, and phosphodiesterase inhibitors have all been attempted after appearance of digital ischemia, but prevention appears to be the best line of management [8,9,[17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

Symmetrical Peripheral Gangrene—A Case Report and Brief Review

et al. 2012

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A 30 year-old gentleman presented to casualty with history of pain abdomen for six days, fever and decreased urine output since two days. He was in a state of septic shock and was diagnosed to have intestinal perforation. His peripheral pulses were not palpable except for the femoral and brachial vessels. Despite fluid resuscitation, he needed infusion of high doses of dopamine and noradrenaline to maintain his blood pressure. He was operated for repair of perforation. On the first postoperative day, in the intensive care unit, vasopressin infusion was added in view of persistent hypotension. Appropriate fluid resuscitation and antibiotic therapy helped to wean him off inotropes and vasopressors by the second postoperative day. On the 3rd postoperative day, however, the patient developed discolouration and blebs on the fingers of left hand, followed by the right hand and then both the lower limbs. Subsequently, over a period of 10 days, this progressed to gangrene formation in the hands despite the patient being haemodynamically stable without any inotropes or vasopressors in this period. We conclude that the septic shock is a systemic derangement affecting all organ systems including coagulation and microcirculation. Early recognition and prompt management of sepsis, optimisation of fluid status to wean off the inotropes and vasopressors at the earliest is necessary to avoid catastrophes such as symmetrical peripheral gangrene.Keywords Symmetrical peripheral gangrene . Sepsis . Vasopressors . Multiple arterial punctures . Resuscitation. Case ReportA 30-year-old man, an agriculturist by occupation, presented to the casualty ward with abdominal pain for 6 days and fever and reduced urine output for 2 days. He was in a state of intense septic shock with absent peripheral pulsations, and the pulse oximeter could not pick up pulsations. Despite fluid resuscitation, he needed high doses of dopamine (20 μg/kg/min) and noradrenaline (0.2-0.3 μg/kg/ min) to maintain normotension. The patient was also found to have altered coagulation parameters which were corrected with fresh frozen plasma. An emergency laparotomy revealed jejunal perforation which was closed. The patient was found to have cirrhotic liver (he was a known chronic alcoholic). Blood pressure remained persistently low, requiring addition of vasopressin infusion in the postoperative period. After multiple failed attempts at cannulation of the radial arteries in both upper limbs, a femoral arterial line was secured in the intensive care unit. By the second postoperative day, all the vasopressors were weaned off. However, cyanosis of the extremities was noted. On the third postoperative day, small blebs/blisters were noticed first in the left hand and subsequently in other limbs also which progressed to gangrene formation over the next 1 week (Figs. 1, 2, 3). Doppler evaluation revealed presence of diminished pulsations in all the vessels supplying the limbs. Echocardiogram revealed absence of any septic foci. While we were waiting for a clear demarca...

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“…Symmetrical peripheral gangrene (SPG) is a rare but severe complication of disseminated intravascular coagulation (DIC) that frequently accompanies sepsis. 1,2 SPG is characterized by symmetric necrosis of the skin and distal extremities, following which two or more distal sites become gangrenous in the absence of large artery occlusion. 1,2 We report four cases of symmetrical peripheral gangrene (SPG) in patients of septic shock.…”

Section: Introductionmentioning

confidence: 99%

Digital gangrene in patients with sepsis

Nema¹,

Darshan²,

Iyer³

2018

Int Surg J

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Background: Symmetrical peripheral gangrene is a rare condition seen in patients of severe sepsis with hypotension. Gangrene is of dry type, limited to the digits only with all peripheral pulses palpable. Methods: Seven patients of severe sepsis with various etiologies were admitted in surgical ICU. These patients developed symmetrical peripheral gangrene during their stay in SICU at a variable period. Detailed history and case records were studied, and data was analyzed. Review of literature was done and compared with findings of our cases. Results: All seven patients had severe sepsis with disseminated intravascular coagulation and all seven required ventillatory support. Administration of inotropes increased the pace of ischemic process. Conclusions: Anticipation and prompt recognition of this condition can limit the progress of gangrene. Treatment is emphasized on the primary condition with focus on limiting the gangrene by local procedures.

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Symmetrical Peripheral Gangrene and Disseminated Intravascular Coagulation

Cited by 100 publications

References 38 publications

Limb fitting for quadruple amputees

Limb fitting for quadruple amputees

Symmetrical Peripheral Gangrene—A Case Report and Brief Review

Digital gangrene in patients with sepsis

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