Peripheral gangrene in children

Abstract

The case histories of 36 patients treated for peripheral gangrene between 1973 and 1987 were reviewed. The commonest causes of gangrene were disseminated intravascular coagulation due to bacterial septicaemia (15 patients) and dehydration due to gastro-intestinal fluid loss (8 patients). In only 2 patients was gangrene of truly iatrogenic origin; in 4 no apparent cause could be found. Secondary or contributing factors were recognisable in the majority. The overall mortality was 30%. Major lower limb amputation was necessary in 5 patients (bilateral in 3). The aetiology of peripheral gangrene was therefore multifactorial in most patients and idiopathic in only a small number. Delay before amputation allows both adequate stabilisation of severely ill patients and clear demarcation of gangrenous tissue.