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Extremity amputation: disseminated intravascular coagulation syndrome
Archives of Physical Medicine and Rehabilitation
|February 1, 1980
Summary
Disseminated intravascular coagulation (DIC) causes peripheral gangrene and extremity amputation after severe infections. This study confirms DIC as the primary mechanism, not septic emboli, in these critical cases.
Area of Science:
- Medicine
- Pathology
- Infectious Diseases
Background:
- Peripheral gangrene and extremity amputation are rare but reported complications following systemic infections.
- Previous hypotheses suggested septic embolization as the cause, but pathological evidence was lacking.
Observation:
- Review of amputation cases post-infection (scarlet fever, varicella, pneumococcemia, appendicitis) revealed evidence of disseminated intravascular coagulation (DIC).
- Two patients with meningococcal and pneumococcal meningitis developed dry gangrene requiring amputation, with confirmed DIC.
- These patients experienced complications in skin healing and prosthetic fitting post-amputation.
Findings:
- Clinical, hematologic, and pathological findings strongly support DIC as the underlying cause of peripheral gangrene.
- DIC involves coagulation abnormalities and tissue pathology leading to dry gangrene and amputation.
Implications:
- Disseminated intravascular coagulation (DIC) is identified as the key pathophysiologic mechanism for peripheral gangrene following systemic infections.
- Understanding DIC's role can improve diagnosis and management of limb-threatening complications in severe infections.
- This finding challenges previous assumptions and highlights the critical need for coagulation assessment in infected patients with ischemic complications.