Symmetrical Peripheral Gangrene

Abstract

Symmetrical peripheral gangrene (SPG), seen in a wide variety of medical conditions presents as symmetrical gangrene of two or more extremities without large vesselobstruction or vasculitis. Fingers, and toes (rarely nose, ear lobes or genitilia) are affected. It may manifest unpredictably in conditions associated with sepsis, low output states, vasospastic conditions, myeloproliferative disorders or in hyperviscosity syndrome. It carries a high mortality rate with a very high frequency of multiple limb amputations in survivors. Disseminated intravascular coagulation (DIC) is seen in majority of cases of SPG. A more or lessstereotyped clinical picture of SPG in spite of ever widening aetiological spectrum is suggestive of DICasthe final common pathway of its pathogenesis. Early recognition of acrocyanosis, quick reversal of DIC, effective management of the underlying condition, haemodynamic stabilization and (perhaps) anticoagulation with low dose heparin (300–500 iu/hour) may be helpful in arresting the progression of pre-gangrenous changes to frank gangrene. Vasopressors such asdopamine should be used judiciously in the presence of Ole. Development of acrocyanosis and increase in serum lactate levels may be indicative of impending SPG and the imperative need to treat DIC as well asthe underlying condition.