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General Surgery · Vascular surgery: dry gangrene
Sample itemA 70-year-old man with atherosclerosis has a shrivelled, black, painless toe with a clear line of demarcation, no pus, and no spreading cellulitis. Which is the most appropriate approach once perfusion has been assessed?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Revascularise if possible and allow demarcation before limited amputation
Dry gangrene from ischaemia without infection is allowed to demarcate while perfusion is improved, then a limited amputation is done at a level that will heal. Emergency proximal amputation is for uncontrolled wet gangrene and sepsis.
Option by option
A. Immediate above-knee amputation
A high amputation is unnecessarily mutilating for dry gangrene of a toe.
B. Hyperbaric oxygen as the only treatment
Hyperbaric oxygen cannot replace revascularisation.
C. Broad-spectrum antibiotics alone
Antibiotics do not restore blood supply in dry gangrene.
D. Revascularise if possible and allow demarcation before limited amputation (correct)
Correct. Improve perfusion and amputate conservatively after demarcation.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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