TOE, TAIL AND LIMB NECROSIS

Necrosis is tissue death. An infrequent problem that we encounter with our reptile patients is necrosis of toes, tail or, rarely, entire limbs. 

We cannot usually find a cause for the problem. In a minority of cases we have been able to identify a cause; these have included:
- infections
- constriction by skin remnants from a poor shed
- malnutrition
- problems with the enclosure
- trauma

The first symptoms are swelling and/or discoloration of the affected body parts. As the problem progresses a distinct line forms where the discolored and sometimes swollen tissue meets the normal tissue. As the problem progresses further, the tissue at this line becomes more and more fragile. Finally the necrotic body part comes off at this line.

One or more body parts can be affected. Body parts can be affected simultaneously or sequencially. It takes several days to several weeks for an individual part to be lost, and several weeks to a few months for the illness to run its course. 

Our patients are usually not painful, do not lose their appetites, or otherwise act ill. 

The diagnosis is made by the patient's history and physical exam. At YVC, an important part of the physical is exam with light and loupes (a medical-quality led light and magnifiers). We can do xrays, blood tests and other diagnostics; these are most important for patients that seem painful, are not eating well, or are otherwise acting sick. 

Treatment options include:
- Watchful waiting, with re-examination, diagnostic testing and additional treatments if the problem is progressing in any way other than as described previously.
- Surgical removal of parts that appear ready to fall off but have not done so.
- Antibiotics or pain medications are not typically needed. 
- Silver sulfadiazine cream, to keep affected parts soft and to encourage them to come off.
- Owner or veterinarian assistance with removal of retained shed.
- Review all aspects of care and assure that it is ideal, in particular diet, and heat, humidity and lighting of the enviroment. 

The prognosis (on a scale of poor, guarded, fair, good, or excellent) is:
- Good to excellent when the problem is necrosis only, and other symptoms or illness do not occur. Lizards can lose multiple toes, the tail, and even entire limbs and still lead excellent quality lives.
- Guarded to poor for patients that have signs of illness (loss of appetite, lethargy, etc.) in addition to necrosis. (In our experience this is a much less common syndrome.)