Symmetrical peripheral gangrene: A new presentation of an old disease

This report concerns two cases and a review of the literature on the subjec t of symmetrical peripheral gangrene. Symmetrical peripheral gangrene is de fined as symmetrical distal ischemic damage in two or more sites in the abs ence of major vascular occlusive disease. It occurs in patients who are sep tic and have disseminated intravascular coagulation and in nonseptic patien ts who have cardiogenic or hypovolemic shock. The syndrome is devastating a nd rare, and controlled studies of its etiology and management are lacking. Recommendations are presented for its prevention and treatment. Cooperativ e multicenter studies may be necessary to obtain valid data about its preve ntion and management.