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A Journal on Physiopathology and Therapy of Chronic Cutaneous Ulcers
Official Journal of the Italian Association for Cutaneous Ulcers
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Acta Vulnologica 2008 March;6(1):43-8
Urgent aggressive surgical therapy in acute infections with wet gangrene of the diabetic foot. Case reports involving open wound treatment and the use of advanced dressings
Gargano V., Farina P., Carbone I., Di Cosmo M.
Divisione di Chirurgia Generale Ospedale S. Francesco d’Assisi Oliveto Citra, Salerno
Wet gangrene is a clinical condition to be managed with absolute, mandatory urgency, there being a very high risk of losing the leg and suffering irreversible septic shock. Gangrene may involve the phalanges and toes including most of the foot (forefoot, midfoot, rearfoot). Our clinical case is one of wet gangrene in a 56-year-old man with severe contralateral Char-
cot’s foot and chronic plantar ulcer. Acute infections of the foot may lead to septic thrombosis of the terminal arteries with irreversible clinical picture of gangrene, even in the absence of arteriopathy and ulcerative lesions. The consequences of an infection are more serious in a diabetic foot due to the impaired inflammatory response, metabolic anomalies and other factors such as neuropathy, oedema and vasculopathy. Aggressive surgical treatment includes the removal of necrotic, infected tissues in association with intravenous antibiotic therapy for at least 15 days. Generally speaking, well conducted emergency surgery enables us to stop the infection while any delay is often associated with an unfavourable prognosis. Depending on what is visible intraoperatively, the immediate decision is whether nor not the wound should remain open or whether it is possible to carry out immediate surgical closure. If the wound is left open, the possibility of skin grafts or treatment with advanced dressings can be assessed. Limited resections with treatment of the open wound are beneficial in the case of foot infection and may preserve important areas subjected to loading.