Mar 04, 2018
Gangrene - necrosis of tissues, which occurs under the influence of various external and internal factors: cessation of arterial blood flow due to blockage, sharp narrowing or prolonged spasm of blood vessels, cessation of outflow of venous blood and blood circulation in capillaries, direct exposure to tissue cells of toxic chemicals, metabolic productspathogenic microbes, electric current, high temperature.
There are two main clinical forms of gangrene: dry gangrene, or mummification of tissues, and moist gangrene. Dry gangrene develops when blood supply suddenly and completely stops and conditions are created favorable for rapid drying and evaporation of liquid from the surface of the necrotic area. In this case, the tissues become dense, rigid, dry, black( like coal).On the border of the deadened area there are a granulation shaft and a demarcation line, and it is gradually rejected.
Wet gangrene develops in cases where evaporation from the surface of the deadened area is difficult or does not occur, then an inflammatory process occurs, caused by purulent or putrefactive infection. At a wet gangrene the expressed phenomena of the general intoxication are observed, a considerable rise in temperature, a pain. Locally there are swelling of the tissues, dark brown spots on the skin, bubbles filled with brown, bloody liquid, areas of putrefactive tissue decay with a sharp unpleasant odor. The demarcation line is not formed.
With dry gangrene, first, conservative therapy is performed: aseptic dressings, measures that improve blood circulation and the general condition of the patient. When the demarcation line is clearly marked, remove the necrotic areas. With moist gangrene, conservative treatment is applied at the very beginning: aseptic drying dressings, antibiotics, sulfanilamide preparations, restorative products. It is necessary to closely monitor the general condition of the patient. With the development of intoxication, an early limb amputation is necessary.
Gas gangrene, gas phlegmon is a serious infectious complication of wound process caused by microbes that reproduce without access to oxygen and has a peculiar flow. Anaerobic microbes form spores and are highly resistant. Do not die when boiling in water for an hour. Microbes are found in decaying organic substances, in the ground( especially often in manure soil), in the intestines of humans and animals. The following conditions contribute to the development of anaerobic infection in the wound: extensive muscle damage, contamination of the wound with foreign bodies, fragments of clothing, circulatory disorders in the affected area( wounding of vessels, superimposed tourniquet), innervation, insufficient immobilization of the limb during transportation with open fractures.
Anaerobic infection is called in different ways: "gas gangrene", "anaerobic gangrene", "anton fire", etc. In peacetime - with accidental injuries in everyday life and at work, gas gangrene is rare. Gas gangrene is caused by pathogens: a) a stick of gas gangrene;b) a stick of malignant edema;c) a stick dissolving the tissue;d) a septic vibrio. Usually these microbes are found in various associations. According to the experience of the Great Patriotic War, in 80% of wounds complications anaerobic infection was caused not by anaerobes alone, but in combination with aerobes. In this case, the rapid multiplication of aerobes leads to the destruction of tissue and the creation of an oxygen-free environment, in which anaerobes are already developing.
During the anaerobic gas infection two phases are distinguished:
1) toxic edema;
2) gas formation and gangrene of muscles and connective tissue.
Anaerobic toxins and degradation products lead to severe intoxication, disrupting the functions of all vital organs and systems. Toxins, acting on the tissue of the wound and the walls of the vessels, make them permeable for plasma and shaped elements. Rapid development of edema and the formation of gases leads to increased interstitial pressure, compression of lymphatic and blood vessels, impaired blood circulation in tissues, resulting in their necrosis. Anaerobes are rapidly multiplying in dead tissues and the process is rapidly progressing. The death of the patient occurs within a few hours.
Patients with gas gangrene should be isolated. They should be given bright, well-ventilated chambers and dedicated experienced personnel. The success of treatment depends on early diagnosis and early comprehensive treatment. The treatment is mostly surgical. They produce wide and deep "lampasnye" incisions with excision of dead tissue and muscles. After that, the wound is treated with substances that release oxygen - a solution of potassium permanganate, hydrogen peroxide, then apply a bandage with hypertonic sodium chloride solution, antiangnogenic bacteriophage solution and provide immobilization.
Immediately I / drip drip a mixture of anti-gangrenous sera. A good effect is given by the hyperbaric oxygenation used in recent years.
Assign abundant drink, high-calorie nutrition, cardiac funds, blood transfusion, antibiotics. In severe cases, limb amputation is performed. How to use folk remedies for this disease look here.
Timely and complete primary surgical treatment of wounds. Patients with extensive contaminated lacerations, with damage to the muscles, especially with open gunshot fractures, should be administered according to the method without a mixture of antigangrenous serums( serum against the stick of malignant edema at a dose of 15 000 AE, against a gangrene stick - 10 000 AE, against septic vibrio -5000 AE).Large doses of broad-spectrum antibiotics are indicated.