Gangrene, foot

Figure 12.2 Diabetic macroangiopathy severe peripheral vascular disease and gangrene of the foot.

A 66-year-old kidney transplant recipient developed a gangrenous lesion on the left foot infected with S. aureus and Escherichia coli. He was given ciprofloxacin and chndamycin for 6 weeks and then fusidic acid 1500 mg/day for 2 weeks. He became Ul, with myalgia and no active movement of his legs, and rhabdomyolysis was established by laboratory tests. He had also taken atorvastatin 10 mg/day and he slowly recovered after withdrawal of both atorvastatin and fusidic acid. 

Martin adds the fact that Coley s Toxins were effective in treating patients having foot ulcers and a gangrenous condition, with symptoms of cold feet and lack of a pulse in the lower leg. Conducted by a Dr. Harry Gray at a Veterans Administration Hospital in the 1930s, amputation was avoided. This treatment is presumed to be effective for diabetic patients with foot ulcers. It is further noted that, at the present, physician Glen Wilcoxson, M.D., of Spanish Fort, Alabama, is treating patients with Coley s Toxins. 

Immersion foot occurs in individuals whose feet have been wet, but not freezing cold, for days or weeks. The primary injury is to nerve and muscle tissue. Symptoms are numbness, swelling, or even superficial gangrene. Trenchfoot is wet cold disease resulting from exposure to moisture at or near the freezing point for one to several days. Symptoms are similar to immersion foot (swelling and tissue damage). 

Interventions for limb salvage are required if a patient develops rest pain, nonhealing ulcers, or gangrene of the toes or foot. After appropriate treatment, rest pain disappears, ulcers heal with standard attention, and gangrenous tissue can be amputated with prompt healing. This allows substitution of a minor toe or forefoot amputation for an otherwise inevitable below- or above-knee amputation. All effort is made to preserve as much extremity as possible so that the potential for rehabilitation is optimal. 

Immunologic Two cases of ciprofloxacin-induced hemorrhagic vasculitis have been reported in two patients with diabetes and infected ischemic foot ulcers after treatment with ciprofloxacin plus clindamycin for 4 and 6 days [48" ]. The vasculitis resolved completely 2 weeks after withdrawal in one case, but progressive infection and gangrene necessitated below-knee amputation in the other. 

Fescue foot is a dry gangrene of the ctremities, affecting primarily the feet, tail, and ears. 

In gangrenous ergotism the affected part (more often a foot than a hand) became swollen and inflamed. The patient experienced violent, burning pains (hence the Fire of St. Anthony). The affected part gradually became numb, turned black, shrank, and finally became mummified and dry. The gangrenous part often separated spontaneously at a joint. 

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