Gangrene is a type of tissue death caused by a lack of blood supply. Symptoms may include discoloration of the skin to red or black, numbness, swelling, pain, skin damage, and coolness. Legs and hands are most often involved. Certain types may present with fever or sepsis.
Risk factors include diabetes, peripheral artery disease, smoking, major trauma, alcoholism, HIV/AIDS, frostbite, and Raynaud's syndrome. Can be classified as dry gangrene, wet gangrene, gas gangrene, internal gangrene, and necrotizing fasciitis. The diagnosis of gangrene is based on symptoms and is supported by tests such as medical imaging.
Treatment may involve surgery to remove dead tissue, antibiotics to treat any infections, and efforts to address the underlying cause. Surgical measures may include debridement, amputation, or the use of maggot therapy. Efforts to treat underlying causes may include bypass surgery or angioplasty. In some cases hyperbaric oxygen therapy may be useful. It is not known how this condition generally occurs.
Video Gangrene
Signs and symptoms
Symptoms may include discoloration of the skin into red or black, numbness, pain, skin damage, and coolness. Legs and hands are most often involved.
Maps Gangrene
Cause
Gangrene is caused by insufficient blood supply (eg, peripheral vascular disease) or infection. It is associated with diabetes and long-term tobacco smoking.
Dry gangren
Dry gangrene is a form of coagulative necrosis that develops in ischemic tissue, where the blood supply is inadequate to keep the tissue alive. It is not the disease itself, but the symptoms of other diseases. Dry gangrene is often caused by peripheral arterial disease, but can be caused by acute limb ischemia. Limited oxygen within the limits of the ischemic extremity decays and bacteria fail to survive. The affected part is dry, shrink and dark reddish black. The separation line usually causes complete separation, eventually falling from the gangrenous tissue if not removed surgically, a process called autoamputation.
Dry gangrene is the end result of chronic ischemia without infection. If ischemia is detected early, when an ischemic injury of gangrene is present, this process can be treated by revascularization (via vascular bypass or angioplasty). However, once the gangrene develops, the affected tissue can not be saved. Since dry gangrene is not accompanied by infection, it does not appear as gangrenous gas or wet gangrene, both of which have septic risks. Over time, dry gangrene can develop into wet gangrene if infection develops in dead tissue.
Diabetes mellitus is a risk factor for peripheral vascular disease and thus for dry gangrene, but also a risk factor for wet gangrene, especially in patients with uncontrolled blood sugar, because elevated serum glucose creates a favorable environment for bacterial infections.
Wet gangrene
Gangrene is wet, or infected, characterized by developing bacteria and has a poor prognosis (compared with dry gangrene) due to sepsis due to free communication between the infected fluid and the circulatory fluid. In wet gangrene, the tissue is infected by saprogenic microorganisms ( Clostridium perfringens or Bacillus fusiformis , for example), which causes the tissue to swell and produce a foul odor. Wet gangrene usually develops rapidly due to blockage of venous (mainly) blood flow or arteries. The affected part is saturated with stagnant blood, which promotes rapid bacterial growth. Toxic products formed by bacteria are absorbed, causing systemic manifestations of sepsis and eventually death. The affected part is edema, soft, rotten, rotten, and dark.
Because of the high mortality associated with infected gangrene, emergency rescue amputations, such as guillotine amputations, are often necessary to limit the systemic effects of infection. Such amputations may be converted into formal amputations, such as knee amputations below or above.
Gas gangrene
Gas gangrene is a bacterial infection that produces gas in the tissues. This can be due to Clostridium , which most often produces alpha toxin C. perfringens , or various nonclostridial species. The infection spreads rapidly when the gas produced by the bacteria develops and infilts into the surrounding healthy tissue. Because of its ability to rapidly spread to surrounding tissues, gangrene gas should be treated as a medical emergency.
Gas gangrene is caused by clostridial species that produce exotoxin bacteria, mostly found in soil, and other anaerobes such as Bacteroides and anaerobic streptococci. These environmental bacteria can enter the muscle through the wound and then multiply in the necrotic tissue and remove powerful toxins, which destroy nearby tissues, producing gas at the same time. 5.9% hydrogen gas composition, 3.4% carbon dioxide, 74.5% nitrogen, and 16.1% oxygen were reported in one clinical case.
Gas gangrene can cause necrosis, gas production, and sepsis. Progress to toxemia and shock are often very rapid.
Other types
- Necrotizing fasciitis is an infection that spreads deep into the body along a network of tissues.
- Noma is a face gangrene.
- Gangren Fournier is a type of necrotizing fasciitis that usually affects the genitals and groin.
- Gangrene of the venous limb may be caused by thrombocytopenia and heparin-induced thrombosis (HITT).
- Severe mesenteric ischemia can cause gangrene in the small intestine.
- Severe ischemic colitis can cause gangrene in the large intestine.
Treatment
The surgical removal of all dead tissue is the mainstay of care for gangrene. Often, gangrene is associated with an underlying infection, and thus gangrenous tissue must be dissolved to inhibit the spread of the associated infection. The required degree of surgical debridement depends on the extent of gangrene, and may be limited to removal of the fingers, toes, or ears, but in severe cases it may involve amputation of the limbs.
Dead tissue alone does not require debridement, and in some cases, such as dry gangrene, the affected part falls ( auto-amputates ), making removal surgery unnecessary.
Because there are often gangrene-related infections, antibiotics are often an important component of gangrene treatment. The life-threatening nature of gangrene requires treatment with intravenous antibiotics in inpatient settings.
After gangrene is treated with debridement and antibiotics, the cause of gangrene can be treated. In the case of gangrene due to critical limb ischemia, revascularization may be performed to treat underlying peripheral arterial disease.
Ischemic disease of the feet is the most common reason for amputation. In about a quarter of these cases the other side requires amputation within the next three years.
In 2005, an estimated 1.6 million people in the United States lived with loss of limbs caused by trauma, cancer or vascular disease; this estimate is expected to more than double to 3.6 million such individuals by 2050. Antibiotics alone are ineffective because they can not penetrate infected tissue adequately. Hyperbaric oxygen therapy (HBOT) is used to treat gangrene gas. HBOT increases the pressure and oxygen content to allow blood to carry more oxygen to inhibit the growth and reproduction of anaerobic organisms. Regenerative treatment therapy developed by Dr. Peter DeMarco to treat diabetic gangrene to avoid amputation. Growth factors, hormones, and skin grafts have also been used to speed healing for gangrene and other chronic wounds.
Angioplasty should be considered if severe blockages in the lower blood vessels (tibia and peroneal arteries) cause gangrene.
History
In early 1028, flies and grubs were commonly used to treat chronic wounds or ulcers to prevent or catch necrotic spread, because some species of maggots eat only dead meat, leaving nearby living tissues unaffected. This practice mostly dies after the introduction of antibiotics, acetonitriles and enzymes for various treatments for wounds. These days, maggot therapy has regained credibility and is sometimes used very effectively in cases of chronic tissue necrosis.
French Baroque composer Jean-Baptiste Lully contracted gangrene in January 1687 when, while performing on Te Deum, he stabbed his big toe with his spear stick (used as a stick). The disease spread to his feet, but the composer refused to amputate his leg, which eventually led to his death in March of that year.
The French king Louis XIV died of gangrene at his feet on September 1, 1715, four days before his 77th birthday.
John M. Trombold writes: "Middleton Goldsmith, a surgeon in the Union Army during the American Civil War, carefully studied hospital gangrene and developed a revolutionary treatment regimen.The cumulative Cumulative Civil Gangrene Hospital mortality is 45 percent." Goldsmith's method, which he apply to more than 330 cases, resulting in mortality below 3 percent. "Goldsmith recommends the use of topical bromide debridement and topical and injectable solutions on infected wounds to reduce the incidence and virulence of" toxic toxins ". A copy of his book was published to Union surgeons to encourage the use of his method.
Etymology
The etymology of gangrene is derived from the Latin word gangraena and from the Greek gangraine (????????), which means "decay of tissue". It has no etymological relationship with the word green, although the affected area turns black, green, or yellowish brown. It is a coincidence that, in the Scottish Lowlands, the words "green gang" (go green) can be regarded as egg eggs for gangrene, because it describes the symptoms of suffering.
References
External links
- Media related to Gangrene in Wikimedia Commons
Source of the article : Wikipedia
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