Peripheral Acute Ischemia and Gangrene during Infancy and Early Childhood

Background/Purpose: Acute peripheral ischemia and gangrene during infancy and childhood is a rare condition of unknown etiology occurs as a result of thrombosis of peripheral arterioles. The exact etiology and best line of treatment of the condition is still controversial. The aim of the present study is a trial to explore the possible etiology and the curative treatment for the condition. Materials & Methods: This study included fourteen infants and children (9 males and 5 females) presented with manifestations of acute peripheral ischemia affecting mainly the hands and/or feet with normal peripheral pulses. Ten patients had history of previous disease two to three weeks before presentation: 3 cases of measles, 3 cases of gastroenteritis, 3 cases of respiratory tract infection and one case of chickenpox. All the clotting tests, showed no significant difference from the controls in all the patients both initially and after clinical improvement. Of the fibrinolytic mechanism, the euglobulin lysis time was significantly prolonged in 10 cases initially. Also, the urokinase sensitivity test was markedly reduced in 11 cases. Treatment with vasodilators and heparin in one group (7 cases) and low molecular weight dextran and aspirin was tried in the second group (7 cases). The improvement of the patients was better in the second group. Results: Within two weeks of treatment erythema and swelling gradually subsided without any residual pathology in 5 patients. Actual gangrene, sloughing occurred in the remaining 7 patients. The gangrene was localized affecting the skin, the fingers and/or toes in 8 patients. Massive gangrene of the whole foot occurred in one patient. Conclusion: Conservative management of such cases was suggested. Spontaneous healing of the raw areas after skin, sloughing occurred over 4-8 weeks in 6 cases and skin grafting was necessary in two patients. Amputation of the gangrenous foot was mandatory in one case.