Gangrene - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Emergencies

Gangrene is a form of necrosis of tissue in a living organism, growing in violation of their blood supply or innervation by direct traumatic impact on them or in some metabolic disorders.

Gangrene can develop into all the tissues and organs of the human body: may be affected skin, subcutaneous tissue, lung, intestine, muscle, gall bladder.The most commonly encountered in clinical practice gangrene of the limbs legs, and abdominal organs (the appendix, gallbladder, intestines and other site.).

Historically gangrene resulting from circulatory disorders of the limbs, has been known to mankind in ancient times;in the medical literature description gangrene occurs in the writings of the ancient physicians Hippocrates and Celsus.

Causes of gangrene

most common cause of gangrene is oxygen starvation of tissues as a result of acute circulatory disorders in them, which can develop as a result of thrombosis or embolism (blockage of circulating in the bloodstream substrate (for example, to break away from the

wall of a blood clot vessel)) of large arteries, injury or surgical ligation of the artery, prolonged compression of the blood vessels tourniquet or tight plaster cast, when pinch abdominal hernias when, in the intestinal volvulus, in some vascular diseases (arteriosclerosis obliterans, occlusive disease, Raynaud's disease).

To develop gangrene can result in exposure to the enzymes of the body that is found in pancreatitis and peptic ulcer disease.Gangrene may also be caused by local effects on tissues and bacteria toxins produced by them, which is observed in anaerobic infections (gas gangrene);metabolic disorders (diabetes), exposure to high and low temperatures tissue (burns and frostbite), electric shocks and aggressive chemicals.

gangrene may contribute to heart failure, anemia, hypovitaminosis, smoking, alcohol reception.

most common causes of limb gangrene in peacetime are thrombosis and embolism, and in war - damaged arteries.

Symptoms of gangrene

Manifestations of the disease depend on the characteristics of the body and the body, which has developed gangrene, and the volume of defeat and his character.Most other common gangrene limb, which can be wet and dry.

Dry gangrene occurs, usually, if slowly progressive disorder of blood supply to the limbs, in the case of a favorable course, it does not progress.Initially there are intense pain in the limb below the artery blockage.limb skin is pale and cold, and then acquires the marble-bluish.Disappears ripple on the peripheral arteries of the extremities, reduced its sensitivity, disturbed movement in it.Fabrics lose moisture and mummified, sealed, wrinkling and acquiring a bluish-black color due to the impregnation of blood pigments.Spreading gangrene limited level sufficient blood supply to tissue, which forms the border between healthy and necrotic tissue (the so-called demarcation shaft).Since dry gangrene decay of dead tissue does not take place and the absorption of the products of the disintegration of a minor, the general condition of the patients remains satisfactory, but the penetration of the dead tissue infections, dry gangrene can go into the wet.

Dry gangrene of the toes in a patient with diabetes.

Wet gangrene occurs usually in patients with elevated during acute circulatory disorders of the limbs of the body weight (injury, acute thrombosis or embolism is a major artery), leading to rapid necrosis of tissues with a high liquid content, which do not have time to dry andbecome a favorable environment for the development of purulent or putrid infection.The finiteness of the first pale, becomes cold, then the skin appear bluish-purple spots and blisters filled with bloody contents with bad odor.Pulse on the peripheral arteries of the limb is not defined, there is an infringement of sensitivity and active movements, progressing rapidly swelling, no tendency to delimitation process.Fabrics are exposed ichorization, turning into a stinking mass testovatoy consistency dirty gray or black.

absorption decay products leads to severe intoxication, resulting in severe general condition of the patient.There have lethargy and sedation of the patient, increased heart rate, decreased blood pressure, increased body temperature.The complexion becomes sallow hue disappears appetite.There is a real threat to the patient's death from poisoning or sepsis.

Gangrene abdominal organs (intestine, gall bladder, appendix) has clinical manifestations of peritonitis.

Gangrene of the small intestine portion (anatomopathological drug).

Gangrene lung shown considerable intoxication, putrid expectoration of sputum with a fetid odor, sometimes - with fragments of dead lung tissue.

When skin gangrene form single or multiple foci of necrosis of the skin, with gangrene can be dry or wet.

Diagnostics gangrene

Laboratory examination:

• Complete blood count (UAC): characterized by leukocytosis (increased white blood cell count of more than 9 x 109 / l) with increasing content of band forms of neutrophils (over 5%).
• Biochemical analysis of blood: in diabetic gangrene is characterized by elevated levels of blood glucose (hyperglycemia);in obliterating atherosclerosis have elevated blood cholesterol levels;
• Blood tests for sterility: used with gangrene complicated by sepsis.(The spread of the infectious agent of purulent focus in the bloodstream).It allows you to determine the nature of the pathogen and determine its sensitivity to antibiotics.
• Investigation of discharge from the wound (especially in wet gangrene) smear microscopy (microscopic examination after special staining material) and bacteriological (isolation of a pure culture on nutrient media) methods, as well makes it possible to establish the nature of the pathogen and determine its sensitivity to antibiotics.

Treatment of gangrene

Complex treatment of patients with gangrene includes:

1) measures to improve the general condition of the patient;
2) activities aimed at the demarcation of viable tissue of dead;
3) activities designed to surgical removal of dead tissue.

General activities are reduced to eliminate intoxication, infection control and optimization of the most important functions of the organs.Apply intravenous solutions of glucose and electrolytes (saline, Ringer's solution), various antibiotics groups them into account the sensitivity identified pathogenic microorganisms, vitamins, diuretics, if necessary - transfusion of blood components.

In diabetic gangrene of great importance is the normalization of the level of glucose in the blood by insulin correction dosages.hyperbaric oxygenation (pressure chamber) used in coronary and anaerobic gangrene.

nature of surgical treatment depends on which body struck, and the prevalence of pathological process.When gangrene of the abdominal cavity shown emergency surgery - laparotomy (opening of the abdomen) and the removal of dead body or its parts (appendectomy, bowel resection, greater omentum), performed in a surgical hospital.

Local treatment with gangrene of the limb is to ensure peace, applying sterile dressings, performing novocaine blockade, prolonged a regional intra-arterial administration of antibiotics, analgesics, and the appointment of vasodilators and anticoagulants.

In dry gangrene of the limbs conduct preventive its transition into the wet: Dry-air bath of low temperature treatment with an alcoholic solution of tannin, ultraviolet irradiation of dead tissue, and surgery (amputation of the limb) is performed routinely after the formation of the demarcation line. In wet gangrene, usually for health reasons immediately produce limb amputation within the viable tissue.

When gangrene of skin excised her dead areas.

Rehabilitation of patients after amputation is reduced to their compliance with the recommendations of the joint for postoperative care, the formation of the stump, the preservation of joint mobility and muscle workout preserved.In case of a favorable postoperative course, within 3-4 weeks after the amputation can be performed primary prosthesis.Modern methods of prosthesis allows people who have suffered amputation, continue your former way of life and maintain social status.

Complications

gangrene Gangrene is a very serious disease that can lead to severe complications, including death.Gangrene of the abdominal cavity leads to the development of peritonitis - an extremely serious condition that requires emergency surgery for health reasons.

lung Gangrene may be complicated by sepsis, pulmonary hemorrhage, acute respiratory cardiovascular failure.

Dry gangrene of the limb without adequate treatment and infection accession can go into the wet.During the wet gangrene can be complicated by the development of severe intoxication and sepsis that can lead to death.

All of the above speaks of the need for early treatment to the doctor at the first signs of gangrene and non-self.

Prevention of gangrene

Prevention of gangrene is reduced to the timely treatment of diseases that could eventually lead to its development:. Diseases of the cardiovascular system, surgical diseases of the abdominal cavity, burns, frostbite, injury, etc. In addition, in acute conditions,associated with impaired circulation, need to quickly restore it (the vessel restoration of integrity if it is damaged, the removal of thrombus and embolus, clogging the lumen of the vessel, the timely removal of tourniquet and so on. n.).

Surgeon Kletkin ME