Gangrene: symptoms, treatment, photos of lower extremities gangrene

Gangrene is the withering away of tissues of a living organism, having a characteristic very dark or gray-green color, developing in those organs that somehow contact with the air.

Particular segment of the limb, whole organ or part of it is affected.

Most often the word "gangrene" refers to the development of necrosis of the segment of the extremity.

Depending on the consistency of the necrotic area and the presence of a certain type of infection in it, the main types of disease are distinguished: wet, dry and gas gangrene. The initial stage of the disease has its own characteristics and causes of emergence.

Dry gangrene

This type of necrosis affects mainly limbs. It develops as a result of one of two options:

1. 1) With a gradual disruption of blood supply in some area,
   
2. 2) When exposed to a segment of the extremity of highly concentrated acid.

Also for dry gangrene are:

1. 1) Clear, visible border with the naked eye between healthy and dying tissues( in medicine this is called the demarcation line);
   
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2. 2) The fabric looks mummified;
   
3. 3) Black or very dark fabric color;
   
4. 4) Develops more often in patients with a small layer of subcutaneous fat;

Dry gangrene is not typical for people with immunodeficiency, patients with diabetes mellitus and people with a source of chronic infection in the body.

Symptoms of dry gangrene

Before the dry gangrene itself develops and its characteristic symptoms, it can be noted that all the sensitivities of this limb have decreased, hair began to fall on it, the skin became drier, the leg or hand( one or several fingers) becameIt is more difficult to move while maintaining the same motor mode. In this case, the patient can already be exposed to the diagnosis of atherosclerosis, endarteritis or other similar disease.

Further below the place of almost complete or complete blockage of the vessels appears severe pain, the limb pales, becomes cold, the pulse just above this site is not determined. Very severe pain lasts for so long( that is, not one day), while among the dying tissues there are living nerve cells, then they disappear, and the affected segment becomes completely insensitive and loses its motor function.

Absorption of products of necrotic tissues is insignificant - the general state of health is almost not disturbed. If the infection does not get into the necrotic tissue, then after a rather large amount of time, self-amputation of the dead segment may occur.

Wet gangrene

It is characterized by the following features:

1. 1) It develops sharply;
   
2. 2) More pronounced in those tissues that are rich in fluid( eg, muscle, fatty tissue);
   
3. 3) The most common causes are severe alkali burns or instantaneous blockage of 75-100% of the vessel diameter with a thrombus or embolus;
   
4. 4) Dying tissue looks larger in volume;
   
5. 5) Gangrene has a reddish, purple or greenish color, on the skin bubbles are formed with a liquid that has both a clear color and a bloody color;
   
6. 6) There is no clear delimitation of dead tissue - inflammation and edema spread far beyond the immediate necrosis;
   
7. 7) When you feel this skin is cold, the crunching of the underlying tissues is felt( this is called crepitation due to the presence of hydrogen sulphide in the tissue);
   
8. 8) Unpleasant odor of affected tissues;
   
9. 9) Wet gangrene is accompanied by severe intoxication due to massive ingestion of necrotic tissue products into the blood.

Symptoms of moist gangrene

This pathology begins to develop sharply, in a site rich in tissues with a high content of cellular and intercellular fluid. If moist gangrene develops on the limb, then the appearance of such local symptoms is typical:

• pale skin;
  
• develops pain in a separate limb segment;
  
• becomes clearly visible pattern of vessels in this place;
  
• on the skin appear blisters as a burn, only with bloody contents;
  
• swelling of the limb;
  
• has an unpleasant smell;
  
• suffers from the general condition of a person: weakness develops, lethargy, pulse rate increases, temperature rises, nausea, vomiting.

If such a gangrene develops in one of the internal organs, the disturbance of the general condition comes to the fore, local symptoms appear: with gangrene of the lung - cough with phlegm, dyspnea;with gallbladder gangrene or bowel area - abdominal pain, vomiting, nausea, bloating.

Gas gangrene

Develops due to the entry into the wound of anaerobic( that is, one that develops in the absence of air oxygen) flora, in particular - Clostridium. At the forefront of this disease are signs of intoxication and damage to important organs, while the gangrene itself resembles a wet one:

1. 1) Rapid increase in the area affected by gangrene;
   
2. 2) Creption of subcutaneous tissue;
   
3. 3) From the wound, which was the place where the infection hit, bubbles of gas are allocated;
   
4. 4) Unpleasant odor from the gangrenous area.

Symptoms of gas gangrene

This gangrene can cause several strains of clostridia, which causes a different clinical picture.

Gas gangrene begins already after 6 hours after falling into the wound of anaerobes. The first symptoms are severe intoxication: tachycardia, fever, confusion.

Symptoms in the affected limb can develop in 4 scenarios:

1. 1) Edema. The wound becomes dry, if you feel the area around it, then you can squeeze out the wound from the wound and gas. The limb acquires a brown color, sensitivity disappears in it, it becomes dead.
   
2. 2) Ointo-toxic form. Edema around the wound very quickly spreads to adjacent tissues, a brown liquid is released from the wound;gas almost does not come out. The skin looks taut, shiny;it is cold to the touch.
   
3. 3) The phlegmonous form. Pus and gases are secreted from the wound, necrosis takes a more limited area.
   
4. 4) The putrefactive form. In this case, the tissues decay intensely, which is accompanied by the release of purulent and putrefactive contents.

This form of gangrene is often localized in the buttocks and chest area, extending inward - either to the rectum, or to the organs located between the two lungs.

Causes of gangrene

Conditionally the causes can be divided into external and internal. We consider each of these groups.

External causes, this is the main group of factors. These include:

1) Mechanical causes - tissue trauma, in which there was a violation of the integrity of blood vessels and nerves:

• crushing;
  
• crushing;
  
• bedsores( see prophylaxis of pressure sores);
  
• such wounds, in which wound was infected.

2) Physical causes: burns and frostbites.

3) Chemical factors: skin contact with concentrated acids, alkalis, phosphorus, arsenic.

4) Effects of ionizing radiation.

Internal causes of

This includes the processes occurring in the body itself, leading to a violation of the blood supply of tissues:

• of the arteries;
  
• obliterating atherosclerosis;
  
• diabetic angiopathy;
  
• Buerger's disease;
  
• Acute arterial thrombosis / embolism;
  
• total deep venous thrombosis;
  
• Raynaud's syndrome.

Diagnosis of gangrene

The diagnosis is based on:

1. 1) Inspection data: gangrene has a characteristic appearance. Also during the examination, pulsation of the arteries is determined, crepitation of subcutaneous tissues can be felt.
   
2. 2) In a general blood test: a significant level of inflammation.
   
3. 3) Biochemical analysis of blood determines the damage caused by the products of the decomposition of internal organs.
   
4. 4) Microbiological blood test: after 5 days, the answer is whether the infection has got into the blood.
   
5. 5) Analysis of the discharge from the wound on the microflora: this is how it is determined( or complicated) gangrene. So it is possible to distinguish gas gangrene from that which was complicated by getting into the wound of a bacterial infection.
   
6. 6) Duplex scanning of the vessels of the affected limb allows understanding the cause of gangrene.
   
7. 7) Vessel arteriography - more detailed examination of the arteries of the affected limb.

Treatment of gangrene

The main treatment for the disease is surgical. Amputation of the affected segment is performed.

With wet infected gangrene - this is an emergency operation performed after preoperative preparation. It includes: drip introduction of physiological solution, blood substitutes, cardiac agents, antibiotics.

Gas gangrene is treated with wide incisions( they are called "lamp-like") through which air will penetrate into tissue, killing anaerobic flora. The wound is drained and washed with solutions that are donators of oxygen: hydrogen peroxide, a weak solution of manganese acid. In the vein, antibiotics of a broad spectrum with exposure to clostridia are necessarily introduced. Also introduced is anti-gangrenous serum. With a rapid build-up of the edema, the limb is amputated.

For dry gangrene, a number of measures are performed that help to reduce the volume of the amputated segment:

1. 1) Operations to remove blood clots or emboli from the vessel;
   
2. 2) Communication between the patient and healthy vessels( bypass) or stenting( establishing a flexible dilating tube along the diameter of the stenotic vessel);
   
3. 3) Carrying out of medicamental improvement of blood supply to the damaged limb.

Complications and Prevention

Gangrene is a life-threatening disease that can cause very serious complications. So, moist limb gangrene can lead to:

• renal failure;
  
• septicemia;
  
• of hepatic insufficiency;
  
• formation of a shock lung.

Gangrene of one of the organs of the abdominal cavity leads to the development of inflammation of the peritoneum and sepsis.
Gangrene lung may be complicated by a septic condition, pulmonary hemorrhage of varying intensity, pulmonary and heart failure. Dry gangrene may be complicated by the development of moist gangrene.

Prevention of gangrene is:

1. 1) Timely treatment of heart and vascular diseases, burns, frostbites, diseases of the chest or abdominal cavity;
   
2. 2) If a person feels that the limbs have become cold, the sensitivity has changed or the color has changed, you need to urgently consult a vascular surgeon for advice;
   
3. 3) Pass prophylactic ultrasound of vessels of the upper and lower extremities;
   
4. 4) In time to treat varicose veins.

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