Gangrene: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body weight, height; further:
  • Inspection (viewing).
    • Skin and mucous membranes
      • [Leading symptoms of dry gangrene:
        • Mummification
        • Shrinkage of the tissue
        • Drying]
      • [Leading symptom in wet gangrene: putrid infection of the mummified, dry, shrunken areas].
      • [in existing diabetes mellitus (type 1, 2) – due topossible sequelae: eg, delayed wound healing, pruritus, recurrent (recurrent) therapy-resistant infections e.g. dermatomycoses; poorly healing wounds, bacterial or mycotic skin infections (furunculosis, candidamycosis); balanitis; periodontal disease (periodontitis)]
      • Additional possible symptoms of existing arteriosclerosis (hardening of the arteries):
        • Extremities (palpation (feeling) of peripheral pulses, looking for edema/water retention).
        • Neck vein congestion?
        • Central cyanosis? (bluish discoloration of skin and central mucous membranes, e.g., tongue).
      • Additional possible symptoms in existing peripheral arterial occlusive disease: ulcerations (skin ulcers) (stage IV according to Fontaine); accompanying symptoms in the further course:
        • Paleness of the affected extremity
        • Clearly thickened nails
        • Shiny skin
        • Hair loss in the affected area
        • Decreased skin temperature
        • Cyanosis – bluish discolored skin due to lack of oxygen]
  • In case of existing diabetes mellitus (type 1, 2): palpation of the pulses [due topossible secondary disease: peripheral arterial occlusive disease (pAVK)].
  • Auscultation (listening) of the heart [in case of existing diabetes mellitus (type 1, 2) – due topossible secondary disease: coronary heart disease (CHD)]
    • In addition, in case of existing arteriosclerosis or peripheral arterial occlusive disease: auscultation of the central arteries (flow sounds?)
  • Auscultation of the lungs
  • Palpation (palpation) of the abdomen (abdomen) (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing knocking pain?)
  • In the presence of peripheral arterial disease: determination of the ankle-brachial index – first, systolic blood pressure is measured at the ankle and upper arm; a quotient is then formed from these values; values for healthy individuals are ≥ 1 (measured from systolic blood pressure at the ankle divided by systolic blood pressure at the upper arm); if the quotient value is less than 0.9, a damaged vascular system is present, and if < 0.7, a higher-grade vascular change is likely.
• Ophthalmological examination
  • In case of existing diabetes mellitus (type 1, 2) – due tovisual disturbances [retinopathy].
• ENT medical examination
  • In case of existing diabetes mellitus (type 1, 2) – due topossible secondary disease: sensorineural hearing loss.
• Neurological examination
  • If arteriosclerosis is present – including testing of reflexes (especially the biceps tendon reflex (BSR), triceps tendon reflex (TSR), radius periosteal reflex (RPR), patellar tendon reflex (PSR), and Achilles tendon reflex (ASR, also triceps surae reflex)), checking sensitivity and motor function [due topossible symptoms:
    • Fleeting paralysis
    • Frequent headaches
    • Dizzy spells
    • Unexplained falls
    • Temporary visual and speech disturbances]
  • With existing diabetes mellitus (type 1, 2) – due toe.g. paresthesias (insensations in the area of a skin nerve) in the area of the feet and lower legs [neuropathy].
• Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.