Gangrene of lower limbs - etiology and clinic
Gangrene is a necrosis of a specific area of the body or organs, in which the affected areas acquire a characteristic color - from bluish-brown to black. This pathology develops when the supply of oxygen to the tissues stops, which is most often observed in the most remote parts of the body.
Thus, most often develops gangrene of the lower extremities, in which the toes are especially often affected. In addition, the disease may develop with localization in areas with a violation of the local circulation, for example, it affects the heart or lung tissue with the development of a heart attack.
Etiology of gangrene
The causes of this disease can be internal and external. Among the external factors that often provoke the development of gangrene, we can distinguish:
- mechanical injuries - injuries that accompany damage not only to tissues, but also vessels and nerves;Bedsores, which cause rapid development of symptoms;
- external triggers are also the effect of physical agents, for example, high or low temperature, which leads to the development of burns or frostbite, as well as ionizing radiation;
- influence of chemical agents( acids, alkalis, phosphorus or arsenic).
Internal causes of this disease include any pathological processes that occur with a violation of normal nutrition of tissues. Most often, such processes develop with damage to the blood vessels, which are accompanied by a violation of their integrity, spasm or anatomical changes, which is often observed in atherosclerosis and can cause not only gangrene, but infarctions and thromboses.
It should be noted that the disease can develop without the involvement of microorganisms. Then they talk about the aseptic form of the disease. If pathogenesis of this lesion involves anaerobic flora, septic( putrefactive) gangrene of the lower extremities develops.
Clinical picture of the disease
Distinguish dry, wet and gas gangrene. Sometimes a special form of this lesion may develop - unauthorized gangrene of the fingers or toes, developing when wearing tight shoes, soaking the feet or after removing the nail that has grown into the surrounding tissues. It should be noted that in the past hospital gangrene developed - a special form of the disease that occurred in cases when a large number of patients with significant injuries were in damp and small rooms with low air temperature and insufficient intake of fresh air.
I must say that the symptoms depend on the form of the disease. Dry gangrene develops with a sudden cessation of blood flow to the tissues, at which they dry up. At the same time, putrefactive infection does not enter necrotic tissues.
Affected tissues wrinkle and thicken, decreasing in volume, which is associated with the disintegration of blood cells and the coagulation of proteins. Necrotic region acquires a dark brown or black color - the so-called mummification.
When the blood supply stops, a sharp pain occurs, the limb becomes pale and becomes cold to the touch, the pulse and sensitivity of the skin in the affected areas disappear. Over time, reactive inflammation develops in the area between the healthy and diseased area. Most often there is dry gangrene of the legs, as well as the tip of the nose and the auricles, especially with chemical burns or frostbites.
If a putrefactive infection gets into the dead tissue, dry gangrene passes into a moist form. The tissues acquire a gray-brown color, swell and increase in volume, soften and acquire a putrefactive odor. Between healthy and diseased tissues a clear boundary is formed.
The necrotic tissue is rejected, after which a defect is formed, which subsequently forms a scar. It is worth noting that the moist gangrene of the lower extremities can go into a dry form.
With the weakening of the body, the pathological process quickly spreads to healthy tissues, and the decay products enter the blood, causing signs of severe intoxication. In severe cases, sepsis may develop, which is especially common among patients who have concomitant diabetes mellitus.
The initial stage of the disease, caused by anaerobic microorganisms, is characterized by soreness and swelling in the area of pathogenic flora. Subsequently, a dark liquid with an unpleasant odor is released from the wound. Affected tissues are destroyed, thus forming a gas, so this form of the disease is called gas gangrene.
I must say that this disease can affect various parts of the body, but more often develops gangrene of the hands or feet. In this case, any form can have an adverse course, characterized by extensive tissue damage, pronounced intoxication and impaired limb function. With complicated course, when conservative methods of therapy do not yield results, they resort to surgical methods, with surgical treatment being most often carried out, which leads to disability of patients.
This is why it is important to prevent the development of this disease, and at the first sign of failure immediately consult a doctor. It is important to detect in a timely manner the conditions and diseases of the body that can lead to the development of gangrene and conduct their persistent and adequate treatment. This will be the best prevention of gangrene of the extremities in patients of any age.