Skin Necrosis and the Need for Vascular Assessments

The need to investigate skin necrosis was never greater. Skin necrosis occurs when skin is acutely deprived of blood and oxygen for a prolonged period resulting in cellular and eventually tissue death, a process that often originates with peripheral arterial disease (PAD). PAD results from atherosclerotic occlusion of the blood vessels causing intermittent claudication, critical limb ischemia, pain, tissue loss, gangrene, ulcers, and necrosis. The global burden of PAD is high: more males are affected by PAD, especially in high-income countries: current data indicate that in low- to middle-income countries, more women than men are affected by PAD. This could and would impact daily-life activities, work, and quality of life: this in turn would affect the global burden. The skin necrosis, gangrene, and unhealed ischemic ulcer are the advanced stage of the PAD, namely chronic limb-threatening ischemia (CLTI). This chapter is an updated review on the methods of investigating both the macro- and the microcirculation, which determine the possibility of wound healing, limb amputation, and benefit of revascularization in patients with CLTI with gangrene or ischemic ulcer.