Because of increasing awareness on the part of both patients and physicians, the incidence of clinical tetanus is decreasing yearly. At present, tetanus almost always occurs in nonimmunized or partially immunized persons, and then only if they are late in seeking treatment or if the threat of possible tetanus infection is unrecognized by the physician. At the Medical University of South Carolina, Charleston, we recently treated a patient in whom tetanus developed as a complication of ischemic gangrene of the left third toe.
Though, penetrating injuries and burns are well-known indications for appropriate prophylaxis, our patient had tetanus that arose from tissue damaged by a primary ischemic process, and the need for tetanus prophylaxis was not appreciated. Prompted by our experience with this patient, we reviewed standard and vascular surgical texts but could find reference to neither the incidence nor the possibility of tetanus as a complication of ischemic gangrene.