gangrene

Basis of gangrene assessment

Keep direct examination, operative observations, imaging and pathology distinguishable, with assessor and date.

1. What evidence supports tissue death rather than ischemia or discoloration alone? boundary
2. Who assessed the tissue, when, and using which examination or investigation? provenance

Qualified gangrene descriptors

Record the clinician's terminology and its supporting observations without allowing the label to supply missing evidence.

1. Which observations support the recorded dry, wet, gas or mixed descriptor? definition
2. If gas gangrene is recorded, what supports clostridial myonecrosis beyond the presence of gas? boundary

Distribution and depth

Document visible involvement separately from suspected or demonstrated deeper involvement.

1. Which sites, sides, organs and tissue compartments are involved? measurement
2. How was the extent measured, and what involvement remains inaccessible to that method? measurement

Adjacent tissue assessment

Keep uncertainty about surrounding tissue explicit and attributable to a clinical assessment.

1. Which adjacent tissues are judged viable, threatened or indeterminate, and on what evidence? boundary
2. What reassessment is needed before the proposed tissue-preservation or removal decision? action

Perfusion deficit and cause

Record site-specific perfusion evidence and distinguish demonstrated causes from background risk factors.

1. What examination, pressure measurement or vascular imaging supports inadequate perfusion at this site? measurement
2. Which vascular event, compression, injury or underlying condition is implicated, and how certain is that attribution? provenance

Infection evidence and organisms

Interpret microbiology with specimen depth, collection timing and prior treatment rather than equating any positive sample with invasive infection.

1. What supports invasive infection, and which tissue compartments are thought to be involved? boundary
2. Where and when were specimens obtained, what was detected, and had antimicrobial treatment already started? provenance

Serial change

Record changes against dated observations, retaining uncertainty when examinations are not comparable.

1. Over what interval have the affected area, swelling, discharge, pain or sensation changed? measurement
2. Do the observations support stability or extension, and were they collected by comparable methods? boundary

Urgent assessment and escalation

Track emergency assessment and specialist involvement. Suspected gas gangrene warrants urgent surgical exploration and debridement under IDSA guidance. [IDSA guideline](https://www.idsociety.org/practice-guideline/skin-and-soft-tissue-infections/)

1. What current observations support suspected sepsis, shock or organ dysfunction? measurement
2. Which team has accepted urgent assessment, and is any pending investigation delaying required intervention? action

Intervention rationale

Record decisions concerning debridement, amputation, perfusion restoration and infection treatment, including goals and responsible clinicians.

1. Which interventions are proposed or completed, and what tissue, perfusion or infection findings justify them? action
2. How do assessed tissue viability, clinical feasibility and the person's goals shape the plan? action

Residual disease and function

Distinguish control of the gangrene episode from wound healing and recovery of function.

1. What evidence shows residual or recurrent necrosis, persistent infection or inadequate perfusion? measurement
2. What tissue loss, healing needs and functional consequences require follow-up or linked rehabilitation records? action

Check these first

Recalled without web access and unsourced; every item is a lead to verify.

• This describes the medical condition; no alternative sense was supplied.
• The listed kinds overlap: dry and wet describe clinical appearance, whereas gas and Fournier gangrene identify infectious or anatomical patterns.
• Recalled information only; verify current coding rules and disease-specific exclusions before using I96.

1. Which of these check these first hold for the sense of gangrene this model covers, and on what evidence? provenance

Kinds and varieties

Recalled without web access and unsourced; every item is a lead to verify.

• Dry gangrene
• Wet gangrene
• Gas gangrene, typically clostridial myonecrosis
• Fournier gangrene, a necrotizing infection of the perineal, genital or perianal tissues

1. Which of these kinds and varieties hold for the sense of gangrene this model covers, and on what evidence? provenance

Identifiers and schemes

Recalled without web access and unsourced; every item is a lead to verify.

• ICD-10 - I96 - World Health Organization category for gangrene, not elsewhere classified; gangrene associated with particular diseases or infections may require other codes.

1. Which of these identifiers and schemes hold for the sense of gangrene this model covers, and on what evidence? provenance

Real-world use

Recalled without web access and unsourced; every item is a lead to verify.

• Recognition of irreversible tissue injury in vascular surgery, emergency medicine and wound care.
• Assessment of complications of peripheral arterial disease and diabetes-related foot disease.
• Distinguishing ischemic tissue loss from rapidly spreading necrotizing infection.
• Documentation of tissue loss and infection when planning revascularization, debridement or amputation.

1. Which of these real-world use hold for the sense of gangrene this model covers, and on what evidence? provenance

Typical measurements

Recalled without web access and unsourced; every item is a lead to verify.

• Extent of affected tissue - No universal range; documented by anatomical distribution, wound dimensions and depth. - cm or cm² for wound dimensions or area

1. Which of these typical measurements hold for the sense of gangrene this model covers, and on what evidence? provenance

Failure modes and hazards

Recalled without web access and unsourced; every item is a lead to verify.

• Permanent tissue loss, potentially requiring amputation.
• Secondary infection of initially dry gangrene.
• Rapid spread of infection and tissue destruction in wet or gas gangrene.
• Sepsis, shock, multiorgan failure and death.
• Delayed recognition when neuropathy reduces pain or affected tissue is not readily visible.

1. Which of these failure modes and hazards hold for the sense of gangrene this model covers, and on what evidence? provenance

Regional variation

Recalled without web access and unsourced; every item is a lead to verify.

• Underlying causes and outcomes vary with the prevalence of diabetes and peripheral arterial disease and with access to vascular, surgical and infection care.
• Diagnostic coding varies between the WHO ICD classification and national modifications.

1. Which of these regional variation hold for the sense of gangrene this model covers, and on what evidence? provenance

Neighbouring kinds and how to tell them apart

Recalled without web access and unsourced; every item is a lead to verify.

• Necrosis - Necrosis is the broader category of cell or tissue death; gangrene describes particular clinical patterns of tissue necrosis associated with ischemia or destructive infection.
• Ischemia - Ischemia is inadequate blood supply and can be reversible; gangrene entails established tissue death.
• Necrotizing fasciitis - Necrotizing fasciitis is an infection spreading through fascia and adjacent soft tissue; gangrene can arise without infection, although Fournier gangrene is a form of necrotizing fasciitis.
• Cellulitis - Cellulitis is an infection of the skin and subcutaneous tissue that does not, by definition, entail tissue necrosis.
• Frostbite - Frostbite is freezing injury that can cause gangrene; gangrene is the resulting tissue-death pattern rather than the cold exposure injury itself.

1. Which of these neighbouring kinds and how to tell them apart hold for the sense of gangrene this model covers, and on what evidence? provenance