Biomaterial Database

Skin demarcation and amputation level for foot gangrene following meningococcal septicemia. 2013

Dishan Singh, and Amanda Swann

Foot and Ankle Unit, Royal National Orthopaedic Hospital, Middlesex, UK.

A case report of a 55-year-old woman who was being considered for bilateral below knee or Syme's amputations after gangrene at the level of both forefeet due to meningococcal septicaemia is described. An expectant approach for 6 months revealed that the tissues deep to the necrotic skin were viable and she was subsequently able to mobilize independently with normal footwear after bilateral toe amputations at the metatarsophalangeal joint levels. This case and a literature review suggest that the demarcation of healthy skin from necrotic skin (eschar) should not dictate the level of amputation in dry gangrene of the foot following meningococcal septicemia. Magnetic resonance imaging can overestimate the degree of muscle necrosis. Treatment should be individualized for each patient, but advice should include the option of prolonged conservative treatment to preserve limb length and function. METHODS Therapeutic, Level IV: Case study.

UI	MeSH Term	Description	Entries
D007238	Infarction	Formation of an infarct, which is NECROSIS in tissue due to local ISCHEMIA resulting from obstruction of BLOOD CIRCULATION, most commonly by a THROMBUS or EMBOLUS.	Infarct,Infarctions,Infarcts
D008279	Magnetic Resonance Imaging	Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques.	Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D008589	Meningococcal Infections	Infections with bacteria of the species NEISSERIA MENINGITIDIS.	Meningococcal Septicemia,Infections, Meningococcal,Meningococcal Disease,Infection, Meningococcal,Meningococcal Diseases,Meningococcal Infection,Septicemia, Meningococcal
D008682	Metatarsal Bones	The five long bones of the METATARSUS, articulating with the TARSAL BONES proximally and the PHALANGES OF TOES distally.	Metatarsals,Bone, Metatarsal,Bones, Metatarsal,Metatarsal,Metatarsal Bone
D008875	Middle Aged	An adult aged 45 - 64 years.	Middle Age
D009336	Necrosis	The death of cells in an organ or tissue due to disease, injury or failure of the blood supply.
D002111	Calcaneus	The largest of the TARSAL BONES which is situated at the lower and back part of the FOOT, forming the HEEL.	Heel Bone,Bone, Heel
D005260	Female		Females
D005528	Foot	The distal extremity of the leg in vertebrates, consisting of the tarsus (ANKLE); METATARSUS; phalanges; and the soft tissues surrounding these bones.	Feet
D005534	Foot Diseases	Anatomical and functional disorders affecting the foot.	Foot Disease