Leg gangrene in a newborn
Leg gangrene in a newborn
Authors
A full-term, vaginally delivered, 7-day-old boy presented with poor feeding, tachypnea, and color change on his leg. His prenatal and family histories were unremarkable. Lethargy, decreased neonatal reflexes, respiratory distress, and a necrotic appearance on the distal left foot were observed (Figure 1A). Left femoral pulse was absent. Laboratory examination revealed metabolic acidosis, hypernatremia, increased serum creatinine and acute phase reactants, and prolonged coagulation parameters. Doppler ultrasound and computerized tomographic angiography revealed decreased calibration in the left external iliac artery, monophasic weak blood flow in the superficial femoral and popliteal arteries, and absence of blood flow in the dorsalis pedis artery (Figures 1B and 1C). Thrombophilia and congenital metabolic disorders were excluded. Low molecular weight heparin and antibiotic therapy led to resolution of the clinical picture except for his leg. Amputation below the knee was performed after demarcation of the gangrene became clear (Figure 1D). He was discharged after an uneventful postoperative period.
Vascular insufficiency of the extremities, leading to ischemic necrosis of a limb, is a serious complication in newborns. Predisposing factors such as prematurity, polycythemia, maternal diabetes, and umbilical catheterization precipitate arterial thrombosis.1 Sepsis and hypovolemia in addition to arterial malformation contributed to thrombosis and eventual gangrene in this patient. Amputation should be delayed until definite demarcation of the gangrenous portion is determined and growth plates should be preserved during amputation to ensure an adequate stump for subsequent prosthetic fitting.2
Declarations
Animal and Human Rights Statement
All procedures performed in this study were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed Consent
Written informed consent was obtained from the patient’s parents for publication of this clinical image and accompanying images.
Data Availability
The datasets used and/or analyzed during the current study are not publicly available due to patient privacy reasons but are available from the corresponding author on reasonable request.
Conflict of Interest
The authors declare no conflict of interest.
Funding
None.
Scientific Responsibility Statement
The authors declare that they are responsible for the scientific content of the article, including study design, data collection, analysis and interpretation, writing, and approval of the final version of the manuscript.
References
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Demirel N, Aydin M, Zenciroglu A, Bas AY, Yarali N, Okumus N, et al. Neonatal thromboembolism: risk factors, clinical features and outcome. Ann Trop Paediatr. 2009;29:271-279. doi:10.1179/027249309x12547917868961
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Letts M, Blastorah B, al-Azzam S. Neonatal gangrene of the extremities. J Pediatr Orthop. 1997;17:397-401. doi:10.1097/01241398-199705000-00023
Figures
Figure 1. A cutaneous and subcutaneous necrotic appearance was present on the distal one-third approximately of the left leg with unclear demarcation (A). Decreased calibration in the left external iliac artery at three-dimensional CT-angiography (arrows) (B). The dorsalis pedis artery is present in the right leg (arrow), while absence of blood flow in the left dorsalis pedis artery can be seen on an axial image of the feet (C). A more prominent demarcation line was observed on the patient’s leg after low molecular weight heparin and antibiotic therapy (D).
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About This Article
- Received:
- April 11, 2018
- Accepted:
- April 28, 2018
- Published Online:
- April 29, 2018
- Printed:
- September 1, 2018