Gangrene and Critical Limb Ischemia

Laura Shin, D.P.M., Ph.D., David Armstrong, D.P.M., M.D., Ph.D., Lee J. Sanders, D.P.M.
Gangrene and Critical Limb Ischemia is a topic covered in the Johns Hopkins Diabetes Guide.

To view the entire topic, please or .

Official website of the Johns Hopkins Antibiotic (ABX), HIV, Diabetes, and Psychiatry Guides, powered by Unbound Medicine. Johns Hopkins Guide App for iOS, iPhone, iPad, and Android included. Explore these free sample topics:

-- The first section of this topic is shown below --

DEFINITION

  • Critical Limb Ischemia (CLI) of a limb is defined as persistent and severe pain in the foot, at rest, preventing sleep, and requiring repeated analgesia. Symptom duration >4 weeks, superficial skin necrosis of the foot or digital gangrene are required to make the diagnosis. Ankle systolic blood pressure < 40mmHg in the presence of rest pain, < 60mmHg in the presence of tissue necrosis.[16]
  • Earlier definitions of CLI excluded patients with diabetes.[16]
  • WIfI: Risk stratification based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection. Refocuses approach to the patient with diabetes who has a threatened limb and a component of chronic ischemia according to disease severity rather than arterial lesion characteristics. Not intended for application to patients with acute limb ischemia, emboli, trauma or non-atherosclerotic disease.[2]
  • Gangrene is necrosis of tissue associated with ischemia (dry gangrene) or infection (wet gangrene).
  • Gas gangrene is a type of wet gangrene caused by infection with anaerobic bacteria (Clostridium) especially C. perfringens.
  • Acute Limb Ischemia (ALI) is defined as a sudden decrease in limb perfusion that threatens the viability of a limb, is associated with high rates of morbidity and mortality, and requires immediate vascular surgical evaluation and intervention.

-- To view the remaining sections of this topic, please or --

DEFINITION

  • Critical Limb Ischemia (CLI) of a limb is defined as persistent and severe pain in the foot, at rest, preventing sleep, and requiring repeated analgesia. Symptom duration >4 weeks, superficial skin necrosis of the foot or digital gangrene are required to make the diagnosis. Ankle systolic blood pressure < 40mmHg in the presence of rest pain, < 60mmHg in the presence of tissue necrosis.[16]
  • Earlier definitions of CLI excluded patients with diabetes.[16]
  • WIfI: Risk stratification based on three major factors that impact amputation risk and clinical management: Wound, Ischemia, and foot Infection. Refocuses approach to the patient with diabetes who has a threatened limb and a component of chronic ischemia according to disease severity rather than arterial lesion characteristics. Not intended for application to patients with acute limb ischemia, emboli, trauma or non-atherosclerotic disease.[2]
  • Gangrene is necrosis of tissue associated with ischemia (dry gangrene) or infection (wet gangrene).
  • Gas gangrene is a type of wet gangrene caused by infection with anaerobic bacteria (Clostridium) especially C. perfringens.
  • Acute Limb Ischemia (ALI) is defined as a sudden decrease in limb perfusion that threatens the viability of a limb, is associated with high rates of morbidity and mortality, and requires immediate vascular surgical evaluation and intervention.

There's more to see -- the rest of this topic is available only to subscribers.

Last updated: July 7, 2020