Advertisement

Rates of Conversion from Dry to Wet Gangrene Following Lower Extremity Revascularization

Published:January 16, 2022DOI:https://doi.org/10.1016/j.avsg.2022.01.005

      HIGHLIGHTS

      • Type of research Retrospective review of data collected from a tertiary care center.
      • Key Finding Rates of Wet Gangrene were 7.7% at 30 days following revascularization with a mean time to conversion of 13.5 days.
      • Take Home Message Rates of conversion from wet to dry gangrene were 7.7% in the first 30 days after revascularization. These data should be considered by clinicians in determining appropriate follow up for gangrenous wounds after revascularization.

      Background

      There is a paucity of data regarding the conversion rate from dry gangrene to wet gangrene after lower extremity revascularization. This study aimed to determine the rate of conversion from dry to wet gangrene within 30 days post-procedure in patients who underwent endovascular or open revascularization for critical limb ischemia. Secondary aims included determining the time to conversion and associated risk factors with conversion.

      Methods

      A multicenter, retrospective review was performed utilizing the MGH/Brigham Healthcare System's Research Patient Data Registry (RPDR). All adult patients who had lower extremity dry gangrene that underwent a revascularization procedure (endo, open, hybrid) from April 2002 to March 2020 were included. Patients who had no lower extremity gangrene, a concurrent amputation with the revascularization procedure, or wet gangrene on initial presentation were excluded. Univariate analysis was performed using the Fisher's exact test and Wilcoxon rank-sum test.

      Results

      There were 1,518 patients identified who underwent revascularization; 194 (12.8%) patients met inclusion criteria and served as our study cohort. There were 15 (7.7%) conversions from dry to wet gangrene within 30 days post-procedure. The mean time to conversion was 13.5 ± 8.6 days. Univariate analysis did not identify any associated risk factors for conversion.

      Conclusions

      The rate of dry to wet gangrene conversion post revascularization is 7.7% within 30 days. The mean time of conversion is 13.5 ± 8.6 days.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Annals of Vascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Campia U
        • Gerhard-Herman M
        • Piazza G
        • et al.
        Peripheral artery disease: past, present, and future.
        Am J Med. 2019; 132: 1133-1141
        • Pérez Mejias EL
        • Faxas SM
        • Taveras NT
        • et al.
        Peripheral artery disease as a risk factor for myocardial infarction.
        Cureus. 2021; 13: e15655
        • Al Wahbi A
        Autoamputation of diabetic toe with dry gangrene: a myth or a fact?.
        Diabetes Metab Syndr Obes. 2018; 11: 255-264
        • Alzahrani H
        • Bedir Y
        • Al-Hayani A
        Efficacy of shellac, a natural product, for the prevention of wet gangrene.
        J Int Med Res. 2013; 41: 795-803
        • Humphries MD
        • Brunson A
        • Hedayati N
        • et al.
        Amputation risk in patients with diabetes mellitus and peripheral artery disease using statewide data.
        Ann Vasc Surg. 2016; 30: 123-131
        • Humphries MD
        • Brunson A
        • Li CS
        • et al.
        Amputation trends for patients with lower extremity ulcers due to diabetes and peripheral artery disease using statewide data.
        J Vasc Surg. 2016; 64: 1747-1755.e1743
        • Skoutas D
        • Papanas N
        • Georgiadis GS
        • et al.
        Risk factors for ipsilateral reamputation in patients with diabetic foot lesions.
        Int J Low Extrem Wounds. 2009; 8: 69-74
        • Joret MO
        • Dean A
        • Cao C
        • et al.
        The financial burden of surgical and endovascular treatment of diabetic foot wounds.
        J Vasc Surg. 2016; 64: 648-655
        • Brocco E
        • Ninkovic S
        • Marin M
        • et al.
        Diabetic foot management: multidisciplinary approach for advanced lesion rescue.
        J Cardiovasc Surg. 2018; 59: 670-684
        • Pulli R
        • Dorigo W
        • Guidotti A
        • et al.
        The role of infrainguinal bypass surgery in the endovascular era.
        Ann Vasc Dis. 2014; 7: 7-10
        • Fereydooni A
        • Zhou B
        • Xu Y
        • et al.
        Rapid increase in hybrid surgery for the treatment of peripheral artery disease in the vascular quality initiative database.
        J Vasc Surg. 2020; 72: 977-986.e971
        • Conte MS
        • Bradbury AW
        • Kolh P
        • et al.
        Global vascular guidelines on the management of chronic limb-threatening ischemia.
        J Vasc Surg. 2019; 69 (3S–125S.e140)
        • Armstrong EJ.
        Advances in the treatment of chronic limb-threatening ischemia.
        J Endovasc Ther. 2020; 27: 521-523
        • Al Wahbi A
        Operative versus non-operative treatment in diabetic dry toe gangrene.
        Diabetes Metab Syndr. 2019; 13: 959-963
        • Salcido R.
        Ulceration of the digits: autoamputation cause and consequence.
        Adv Skin Wound Care. 2015; 28: 342
        • Wukich DK
        • Raspovic KM
        • Suder NC.
        Patients with diabetic foot disease fear major lower-extremity amputation more than death.
        Foot Ankle Spec. 2018; 11: 17-21
        • Ang C
        • Lim Y
        Recurrent admissions for diabetic foot complications.
        Malays Orthop J. 2013; 7: 21-26
        • Fikri R
        • Bicknell CD
        • Bloomfield LM
        • et al.
        Awaiting autoamputation: a primary management strategy for toe gangrene in diabetic foot disease.
        Diabetes Care. 2011; 34: e134