Clinical Manifestations

In dry gangrene, the arterial supply is gradually cut off and a drying or mummification of the tissues results. There is frequently an absence of inflammation, but pain of varying degree may precede the color changes. The soft tissue slowly and progressively shrinks and the color gradually deepens until the whole area is coal black. Constitutional symptoms may occur but are less severe than in moist gangrene.

Moist gangrene may be preceded by inflammation or trauma. The part is initially swollen and painful. The color is at first red then blue and finally turns to a green black. There is boggy swelling and putrid odor. If the moist gangrene is extensive, constitutional symptoms, such as fever, may be present.

A vivid description of hospital gangrene illustrates well the clinical aspect of moist gangrene:

A wound attacked by gangrene in its most concentrated and active form presents a horrible aspect after the first forty-eight hours. The whole surface has become of a dark-red color, of a ragged appearance, with blood partly coagulated, and apparently half putrid, adhering at every point. The edges are everted, the cuticle separating from half to three-fourths of an inch around, with a concentric circle of inflammation extending an inch or two beyond it; the limb is usually swollen for some distance, of a white, shining color, not peculiarly sensible except in spots, the whole of it being oedematous and pasty. The pain is burning and unbearable in the part itself, while the extension of the disease, generally in a circular direction, may be marked from hour to hour; so that in from another twenty-four to forty-eight hours nearly the whole of a calf of a leg, or the muscle of a buttock, or even the wall of the abdomen may disappear, leaving a deep great hollow or hiatus of the most destructive character, exhaling a peculiar stench which can never be mistaken, and spreading with a rapidity quite awful to contemplate. The great nerves and arteries appear to resist its influence longer than the muscular structures, but these at last yield; the largest nerves are destroyed, and the arteries give way, frequently closing the scene, after repeated hemorrhages, by one which proves the last solace of the unfortunate sufferer. . . . The joints offer little resistance; the capsular and synovial membranes are soon invaded, and the ends of the bones laid bare. The extension of this disease is in the first instance through the cellular structures. The skin is undermined and falls in, or a painful red and soon black patch is perceived at some distance from the original mischief, preparatory to the whole becoming one mass of putridity, while the sufferings of the patient are extreme. (Buck 1902)

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