Gangrene is the death of a part of the body. Any tissues and organs can be affected – skin, subcutaneous tissue, muscles, intestines, gallbladder, lungs, etc. There are dry and wet gangrene.
Dry gangrenemore often develops in violation of the blood circulation of the limb in emaciated, dehydrated patients. With the slow development of necrosis, the tissues dry out, wrinkle, mummify, become dense and acquire a dark brown or black color with a bluish tint. Dry gangrene traditionally does not progress, being limited to a part of the limb segment. The onset of clinical manifestations is characterized by the appearance of severe ischemic pain below the site of occlusion of the vessel. The limb becomes pale, then the skin acquires a marble appearance, becomes cold to the touch, the pulse is not palpable. Susceptibility is lost, there is a feeling of numbness of the leg. Pain sensations persist for a long time, which is explained by the preservation of nerve cells among dead tissues and reactive tissue edema above the focus of necrosis. Along with the violation of the patency of the main main vessel, a spasm of collateral arterial branches is traditionally noted, which accelerates and expands the necrotic process. Starting in the peripheral parts of the limbs, gangrene spreads upward to the level of occlusion of the vessel or slightly below. With a favorable flow, a demarcation (protective) shaft gradually develops at the border of dead and healthy tissues. Complete tissue rejection and recovery is a long process. Microorganisms in dry tissues develop poorly, however, in the initial phases, the putrefactive microflora that has entered them can cause the transition of dry gangrene to wet. In this regard, before the tissues dry, it is especially important to observe asepsis. With dry gangrene, there is almost no decay of dead tissues, and the absorption of toxic products is so non-cardinal, that intoxication is not observed. The general condition of the patient suffers little. This allows without great risk to postpone the operation of removing dead tissue (necrectomy) or amputation until the full and distinct manifestation of the demarcation shaft.
Wet gangrene, putrefactive, is caused by the same reasons as dry, but more often develops with a rapid circulatory disorder (embolism, vessel injury, etc.) in full, pasty (edematous) patients. In these cases, dead tissues do not have time to dry out, they undergo putrefactive decay, which leads to abundant absorption of decay products into the body and severe intoxication of the patient. Dead tissues serve as a good breeding ground for viruses that develop rapidly, which leads to the rapid spread of gangrene. Wet gangrene develops with necrosis of internal organs (intestines, gallbladder, lungs), thrombosis of large veins (iliac, axillary, mesenteric, etc.) and insufficiency of venous collaterals while maintaining arterial blood flow. Its prolonged stagnation and swelling of tissues during blockage of veins by a thrombus cause spasm,
The clinical picture of wet gangrene begins with blanching of the skin of the affected limb and the appearance on it of a visible network of bluish veins, dark red spots, blisters of exfoliated epidermis filled with sanious contents. The disintegrating tissues turn into a fetid wet mass of gray-dirty green color. Of the general symptoms, there is a severe general condition, pain in the affected limb, frequent small pulse, low blood pressure, dry tongue, high temperature, lethargy, lethargy, etc.
Severe intoxication of the body with tissue decay products and bacterial toxins, emanating from the focus of gangrene, leads to the fact that demarcation does not have time to develop, the necrosis process progressively spreads, which poses a threat to the life of patients who may die from sepsis. Moist gangrene is especially difficult in patients with diabetes mellitus due to a sharply reduced body resistance and high blood sugar.
Gas gangrene is a subfascial anaerobic infection, accompanied by necrosis of muscle tissue and severe intoxication of the body. The disease is caused by obligate anaerobes (Cl. perfringens, Cl. novyi, CI. septicum, Cl. histolyticum), which live in the ground and street dust. Wounds contaminated with earth, having wound pockets, areas of necrosis, poorly vascularized tissues that have not undergone primary surgical treatment, are predisposed to gas gangrene. The causative agent quickly acquires virulence, releases gas-forming and tissue-dissolving exo- and endotoxins, which contribute to the rapid spread of infection.
Symptoms, course of gas gangrene . Already after 6 hours after the acquisition of virulence by the microbe, there are violations of the general condition with tachycardia and fever. The skin is gray-blue. The wound is sharply painful, its edges are pale, edematous, lifeless, the bottom of the wound is dry. The color of the muscles visible in the wound resembles boiled meat. When pressing on the edges of the wound, gas bubbles with an unpleasant sweetish-putrefactive odor are released from the tissues. Fingers define typical crepitus. The patient’s condition deteriorates rapidly, shock begins. X-ray determined “porosity” of muscle tissue. Differential diagnosis is carried out with 31 and fascial gas-forming phlegmon (no muscle damage) and putrid infection.
Death prevention. Consists of activities:
- for the prevention, early diagnosis and treatment of a number of diseases, a complication or consequence of which is gangrene (acute surgical, heart diseases, injuries, endarteritis, etc.);
- to restore impaired blood circulation (development of collateral vessels, removal of spasm of the main vessels, embolectomy – removal of a blood clot, etc.).
Treatment of gangrene. It is aimed at combating intoxication, infection and improving the functions of the cardiovascular system. Large amounts of liquids (glucose, isotonic solution, blood substitutes) are administered in various ways (subcutaneously, intravenously, orally), antibiotics, cardiac drugs, blood, plasma, etc. are transfused. Local treatment consists in removing dead tissues, an organ. With dry gangrene of a limb segment, surgery may be delayed until the dead tissue is completely limited.
With wet gangrene, an increase in intoxication and high temperature force an early amputation of limbs within healthy tissues to save lives. Patients with gangrene of the abdominal organs are shown immediate abdominal surgery to remove the affected organ.
Treatment of gas gangrene . “Pampas” incisions of the skin, muscles, fascia with excision of necrotic and suspicious areas for necrosis. Drain the wound with lavage with a solution of hydrogen peroxide and antibiotics, the wound remains open. Absolute rest of the limb. Penicillins up to 20,000,000-40,000,000 IU / day. (2-3 times every day in / in) for 10-14 days, tetracyclines. Antigangrenous serum and toxoid are ineffective both in the treatment and in the prevention of gas gangrene. With a rapid increase in intoxication – guillotine amputation of the limb. Hyperbaric oxygen therapy is effective, but it does not exclude surgical debridement of the wound, the indications for which are clinical and radiological signs of gas gangrene with microscopically proven presence of Clostridium in the wound.
The prognosis is always very serious.