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The family physician diagnosed peripheral arterial disease. PAD is an important factor leading to lower extremity amputation in patients with diabetes. Thirty percent of patients with diabetes who have an absent pedal pulse will have some degree of coronary artery disease.
PAD manifests in the lower extremity in 2 ways: macro- and microvascular diseases. Risk factors such as hypercholesteremia, hyperlipidemia, and hypertension are often associated with patients with PAD and, therefore, poor wound healing.
Dry, black eschar commonly begins distally at the extremities. There is a clear demarcation between healthy tissue and necrotic tissue. Pain may be present, and trauma is the most common etiology. Pulses may be nonpalpable. Smoking is commonly associated with this problem. Associated trophic skin changes include absent pedal hair and thin shiny skin.
Even in the presence of a palpable pulse, noninvasive studies (eg, arterial Doppler and pulse volume recordings) are important for baseline assessment of the patient’s blood flow. An angiogram is required to evaluate the possibility of revascularization. Radiographs may be necessary to rule out osteomyelitis.
This patient was admitted for IV antibiotics and revascularization was performed. Subsequently, the toes were partially amputated and the wounds healed without complication. Physicians attempted to help the patient to quit smoking, but were unsuccessful.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: La Fontaine J, Shibuya, N. Dry gangrene. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:912-913.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
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The family physician diagnosed peripheral arterial disease. PAD is an important factor leading to lower extremity amputation in patients with diabetes. Thirty percent of patients with diabetes who have an absent pedal pulse will have some degree of coronary artery disease.
PAD manifests in the lower extremity in 2 ways: macro- and microvascular diseases. Risk factors such as hypercholesteremia, hyperlipidemia, and hypertension are often associated with patients with PAD and, therefore, poor wound healing.
Dry, black eschar commonly begins distally at the extremities. There is a clear demarcation between healthy tissue and necrotic tissue. Pain may be present, and trauma is the most common etiology. Pulses may be nonpalpable. Smoking is commonly associated with this problem. Associated trophic skin changes include absent pedal hair and thin shiny skin.
Even in the presence of a palpable pulse, noninvasive studies (eg, arterial Doppler and pulse volume recordings) are important for baseline assessment of the patient’s blood flow. An angiogram is required to evaluate the possibility of revascularization. Radiographs may be necessary to rule out osteomyelitis.
This patient was admitted for IV antibiotics and revascularization was performed. Subsequently, the toes were partially amputated and the wounds healed without complication. Physicians attempted to help the patient to quit smoking, but were unsuccessful.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: La Fontaine J, Shibuya, N. Dry gangrene. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:912-913.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link:
|
The family physician diagnosed peripheral arterial disease. PAD is an important factor leading to lower extremity amputation in patients with diabetes. Thirty percent of patients with diabetes who have an absent pedal pulse will have some degree of coronary artery disease.
PAD manifests in the lower extremity in 2 ways: macro- and microvascular diseases. Risk factors such as hypercholesteremia, hyperlipidemia, and hypertension are often associated with patients with PAD and, therefore, poor wound healing.
Dry, black eschar commonly begins distally at the extremities. There is a clear demarcation between healthy tissue and necrotic tissue. Pain may be present, and trauma is the most common etiology. Pulses may be nonpalpable. Smoking is commonly associated with this problem. Associated trophic skin changes include absent pedal hair and thin shiny skin.
Even in the presence of a palpable pulse, noninvasive studies (eg, arterial Doppler and pulse volume recordings) are important for baseline assessment of the patient’s blood flow. An angiogram is required to evaluate the possibility of revascularization. Radiographs may be necessary to rule out osteomyelitis.
This patient was admitted for IV antibiotics and revascularization was performed. Subsequently, the toes were partially amputated and the wounds healed without complication. Physicians attempted to help the patient to quit smoking, but were unsuccessful.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: La Fontaine J, Shibuya, N. Dry gangrene. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:912-913.
To learn more about The Color Atlas of Family Medicine, see:
• http://www.amazon.com/Color-Atlas-Family-Medicine/dp/0071474641
You can now get The Color Atlas of Family Medicine as an app for mobile devices including the iPhone and iPad by clicking this link: