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Updated: May 17, 2025
Handley argues against the embolic origin of the metastases in the bones because of the rarity of these in the bones of the distal parts of the limbs, because of the fact that secondary cancer of the femur nearly always commences in the upper third of the shaft, which harmonises with the intimate connection of the deep fascia with the periosteum over the great trochanter, thus favouring invasion of the bone marrow when permeation has spread thus far.
There may be a slight inflammation or actual ulceration and loss of tissue. Vegetations more or less constantly occur on the inflamed surfaces, with more or less danger of particles becoming loosened and moving free in the blood stream, causing embolic obstruction in different parts of the body.
Definition Types: Dry, Moist Varieties Gangrene primarily due to interference with circulation: Senile gangrene; Embolic gangrene; Gangrene following ligation of arteries; Gangrene from mechanical causes; Gangrene from heat, chemical agents, and cold; Diabetic gangrene; Gangrene associated with spasm of blood vessels; Raynaud's disease; Angio-sclerotic gangrene; Gangrene from ergot.
When an embolus becomes impacted at the bifurcation of the popliteal, if gangrene ensues it usually spreads well up the leg. When the axillary artery is the seat of embolic impaction, and gangrene ensues, the process usually reaches the middle of the upper arm.
Fibrin readily deposits on this calcareous substance and may form a permanent capping, or may slowly disintegrate and allow fragments to fly off into the blood stream and cause more or less serious embolic obstruction.
In the malignant form the infection is probably more serious or the infective germs are more active, the ulcerations deeper, and the likelihood of emboli and the seriousness of such embolic infarcts more serious and more dangerous.
In some cases the vessel wall is softened by arteritis especially the embolic form so that it yields before the pressure of the blood. Repeated and sudden raising of the arterial tension, as a result, for example, of violent muscular efforts or of excessive indulgence in alcohol, plays an important part in the causation of aneurysm.
While the occurrence of purely periosteal suppuration is regarded as possible, we are of opinion that the embolic form of staphylococcal osteomyelitis always originates in the marrow.
Treatment. The general treatment of embolic gangrene is the same as that for the senile form. Success has followed opening the artery and removing the embolus. The artery is exposed at the seat of impaction and, having been clamped above and below, a longitudinal opening is made and the clot carefully extracted with the aid of forceps; it is sometimes unexpectedly long (one recorded from the femoral artery measured nearly 34
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