Epidemiology

Gangrene occurs equally in men and women. Type I necrotising fasciitis occurs most commonly in patients with diabetes and patients with peripheral vascular disease. It is the most common form of necrotising fasciitis in the general population.[5] Type II necrotising fasciitis has an annual incidence of 5 to 10 cases per 100,000 in the US. Approximately, half of the cases of streptococcal necrotising fasciitis occur in young and previously healthy people.[16]

The incidence of gas gangrene in the US is nearly 3000 cases annually. Severe penetrating trauma or crush injuries associated with interruption of the blood supply are the usual predisposing factors.[17] Spontaneous gas gangrene caused by Clostridium septicum may be more common than trauma-associated gangrene, caused by other Clostridium species.[18] Among drug abusers C perfringens, C sordellii, and C novyi are most commonly involved.[5]

Among patients with atherosclerosis, the annual incidence of atheroembolism that leads to ischaemic gangrene ranges from 0.3% to 3.5% overall, although after a vascular procedure it can rise to 30%.[19] Patients with antiphospholipid syndrome can develop distal gangrene in up to 9% of cases.[20][21] In malignancy affected by paraneoplastic acral vascular syndrome, the most common skin finding is acute digital gangrene, which occurs in 60% of cases. Most patients with Raynaud's phenomenon are women aged between 20 and 40 years, in whom lesions develop during the cold months.[20]

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