Gangrene other diagnostic studies

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:  Edzel Lorraine Co, D.M.D., M.D.

## Overview

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There are some useful tools that were developed to assess for the possibility of gangrene. These include the recent development of the Society of Vascular Surgery which is called WIfI which stands for wound, ischemia, foot infection [1], and the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score [2] [3].

## Other Diagnostic Studies

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* There are some useful tools were developed to assess the possibility of gangrene.
* These include:
* WIfI (wound, ischemia, foot infection) Classification [1]
* This can anticipate the need for revascularization if the result shows a high risk for amputation.
* Score can range from 0 to 3.
* Score of 1 is given to a salvageable minor tissue loss by doing a simple amputation.
* Score of 2 is given to multiple digital amputations or transmetatarsal amputations.
* Score of 3 signifies an extensive tissue loss requiring extensive amputation.

* Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score [2] [3].
* This is based on the results of complete blood count, sodium level, glucose level, C-reactive protein, and creatinine. [2] [3]
* Increased mortality in these patients with gangrene is suggested by the following [4] [5] [6] [7]:
* Increased age (>60 years old)
* Clostridial infection
* Head, neck, abdomen, or thoracic involvement
* Leukocytosis (White blood cell count of more than 30,000 per microliters, and band neutrophils of more than 10 percent)
* Serum creatinine of more than 2.0 mg/dL
* Delayed surgical treatment for more than 24 hours.

## References

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1. ↑ 1.0 1.1 Elsayed S, Clavijo LC (2015). "Critical limb ischemia". Cardiol Clin. 33 (1): 37–47. doi:10.1016/j.ccl.2014.09.008. PMID 25439329.
2. ↑ 2.0 2.1 2.2 Wong CH, Khin LW, Heng KS, Tan KC, Low CO (2004). "The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections". Crit Care Med. 32 (7): 1535–41. doi:10.1097/01.ccm.0000129486.35458.7d. PMID 15241098.CS1 maint: Multiple names: authors list (link)
3. ↑ 3.0 3.1 3.2 Wu PH, Wu KH, Hsiao CT, Wu SR, Chang CP (2021). "Utility of modified Laboratory Risk Indicator for Necrotizing Fasciitis (MLRINEC) score in distinguishing necrotizing from non-necrotizing soft tissue infections". World J Emerg Surg. 16 (1): 26. doi:10.1186/s13017-021-00373-0. PMC 8157441 Check `|pmc=` value (help). PMID 34039397 Check `|pmid=` value (help).CS1 maint: Multiple names: authors list (link)
4. ↑ Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO (2003). "Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality". J Bone Joint Surg Am. 85 (8): 1454–60. PMID 12925624.CS1 maint: Multiple names: authors list (link)
5. ↑ Darenberg J, Luca-Harari B, Jasir A, Sandgren A, Pettersson H, Schalén C; et al. (2007). "Molecular and clinical characteristics of invasive group A streptococcal infection in Sweden". Clin Infect Dis. 45 (4): 450–8. doi:10.1086/519936. PMID 17638193.CS1 maint: Multiple names: authors list (link)
6. ↑ Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E (2005). "Predictors of mortality and limb loss in necrotizing soft tissue infections". Arch Surg. 140 (2): 151–7, discussion 158. doi:10.1001/archsurg.140.2.151. PMID 15723996.CS1 maint: Multiple names: authors list (link)
7. ↑ Huang KF, Hung MH, Lin YS, Lu CL, Liu C, Chen CC; et al. (2011). "Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution". J Trauma. 71 (2): 467–73, discussion 473. doi:10.1097/TA.0b013e318220d7fa. PMID 21825948.CS1 maint: Multiple names: authors list (link)