Concurrence of symmetrical peripheral gangrene and venous limb gangrene following polytrauma: a case report

• DOI: 10.1186/s13256-018-1684-1
• Publication Date: 2018-05-02T12:59:44Z
• Authors: Jih Huei Tan; Yuzaidi Mohamad; Chor Lip Henry Tan; Mahazir Kassim; Theodore E. Warke...
• Keywords: Gangrene; Polytrauma

Symmetrical peripheral gangrene is characterized as acral (distal extremity) ischemic limb injury affecting two or more extremities, without large vessel obstruction, typically in a symmetrical fashion. Risk factors include hypotension, disseminated intravascular coagulation, and acute hepatitis ("shock liver"). In contrast, venous by occurring with deep vein thrombosis. Both present necrosis despite presence of arterial pulses. The coexistence rare, potential to provide pathophysiological insights.A 42-year-old Chinese man presented polytrauma (severe head injury, lung contusions, right femur fracture). Emergency craniotomy debridement thigh wound were performed on presentation. Intraoperative hypotension secondary bleeding was complicated transient need for vasopressors liver enzyme elevation indicating shock liver. Beginning postoperative day 5, he developed an platelet count fall (from 559 250 × 109/L over 3 days) associated left iliofemoral thrombosis that evolved bilateral lower necrosis; ultimately, the extent greater (requiring below-knee amputation) versus (transmetatarsal amputation). As key feature known localize microthrombosis hence gangrene, concurrence unilateral typical clinical setting (hypotension, proximate liver, consistent coagulation) helps explain asymmetric - manifesting degree amputation affected patient whose picture otherwise resembled gangrene.Concurrence explanation