A review of diagnosis and modes of presentation of tropical idiopathic lower limb gangrene.

BACKGROUND Tropical idiopathic lower limb gangrene (TILLG) is also known as Symmetrical gangrene in the African, Idiopathic gangrene in the African and Idiopathic peripheral gangrene of the tropics. The aetiopathogenesis of this clinical entity is a mystery. OBJECTIVE To review methods of diagnosing tropical idiopathic lower limb gangrene (TILLG) and highlight its clinical variants. METHOD All Literature on idiopathic gangrene of the extremities was searched from libraries, colleagues and internet but only literature on TILLG (in Africans) from 1947 to date was scrutinised. Each case was studied to find out the basis of diagnosis. RESULT TILLG is not fully understood and not easy to recognise. Two sets of criteria are known to be helpful in establishing diagnosis. These criteria can be classified as major and minor criteria. Major criteria are those clinical data that can establish the diagnosis of TILLG. No devices are required to identify them. Minor criteria are pathological changes that are consistent with TILLG. Devices are required to identify them. Three pathomorphological types of TILLG were described in literature and are classified as types A, B and C. CONCLUSIONS This review is supposed to sensitise the clinician and make diagnosis easier. This will also encourage more researches. As more information becomes available, aetiopathogenesis of TILLG will be clearer and more clinical variants of the disease may be reported. This additional information will help in the prevention of gangrene, reducing the socioeconomic problems arising from amputation.