Gangrene: what you need to know to prevent the disease. Gangrene - causes, types (dry, wet, gas, etc.), first signs, symptoms and forms, diagnosis, methods of treatment

There are many diseases that endanger human life. If you do not seek help in time, you can remain disabled for life. One such disease is gangrene. Let's see why it occurs, how to treat and what is the prognosis of this disease.

What kind of disease is gangrene?

Mention of this disease was found in Hippocrates and Celsus. The word "gangrene" comes from the Greek graino, which means "to gnaw." In the old days, people called this disease "Anton's fire."

Gangrene is a disease characterized by the death of body tissues. They reach black, brown or dark blue. Gangrene can spread to both tissues and organs. For example, in skin cells, subcutaneous tissue, muscles, lungs, intestines, and so on. This disease can progress quickly or slowly.

The darkening of dead tissues is explained by the fact that hemoglobin accumulates in these areas, which releases iron, it is converted into salt - it is this compound that gives such a color. The most susceptible to gangrene are people suffering from diseases of the heart and blood vessels in old age. With impaired blood flow, blood circulates poorly, especially in places far from the heart, so the hands and feet are most often susceptible to this disease.

How is gangrene classified?

This disease is divided on several grounds.

1. According to the composition of the affected tissue:

• wet gangrene.

2. According to the etiology of the disease, gangrene is:

• infectious;
• allergic;
• toxic.

3. By pathogenesis:

• gas;
• lightning fast;
• hospital.

As a rule, the development of the wet form proceeds quickly, and the dry gangrene develops slowly.

Causes of tissue necrosis

There are several causes of any type of gangrene:

1. Violation of blood circulation. It is broken gradually, while the lower limbs are more vulnerable. This is how dry gangrene develops. And there are also factors that can contribute:

• strongly squeezing, incorrectly applied plaster cast, it compresses the vessels and disrupts blood flow;
• long stay under squeezing heavy objects during disasters;
• a tourniquet that stops bleeding is on the arm or leg for a long time.

2. Diseases of the cardiovascular system:

• heart pathology;
• atherosclerosis;
• thrombosis;
• thromboembolism;
• obliterating endarteritis.

3. Infection. Gangrene may develop as a result of infection during an open injury. Great danger of wounds for diabetics and people with vascular disease. There are always microbes in the soil that can cause gangrene when they get into the wound:

• enterobacteria;
• coli;
• streptococcus;
• Proteus.

The most dangerous are clostridia, which can cause gas gangrene, and they live in an environment that does not have oxygen.

4. Frostbite and burns. Dry gangrene can occur with burns with chemical acids, as well as alkalis.

Under such influences, tissues are destroyed, blood circulation is disturbed, and the inflammatory process joins. If the body is weakened by diabetes mellitus, cardiovascular disease, it is easier for infections to penetrate and take over.

5. Mechanical injuries.

If tissue damage has occurred over a large area, infection can very easily join.

Dry gangrene is not life threatening, unlike wet gangrene. Let's consider it in more detail.

Signs and development of dry gangrene

And now about how dry gangrene arises and proceeds. Symptoms may appear in the following order:

Over time, the affected area dries up, may detach. It equates to recovery. What the limb on which dry gangrene develops looks like, the photo clearly demonstrates.

Warning signs of illness

There are signs to watch out for. Their appearance may be the first symptom of the development of gangrene. After all, dry gangrene can develop over the years.

• Freezing of limbs even in hot weather.
• Rapid fatigue when walking, pain in the legs.
• Cramps of the limbs.
• Injuries, even small ones, for a long time on the foot or leg.
• The gangrenous area loses sensitivity.
• From pale color goes to cyanotic, then begins to blacken.
• Ulcers appear on the affected area, which do not heal well.

Do not leave these signs unattended, it is advisable to rush to the doctor.

Dry and wet gangrene are two concepts that have a very thin line between each other, since the first can go into the second, and then the prognosis regarding the disease will become more gloomy. And when treating the wet form, doctors strive to achieve dry gangrene so that it does not threaten the patient's life.

How is gangrene diagnosed?

If you find signs of gangrene development, you should consult a surgeon. You may need to consult a more specialized specialist, depending on the location of the affected area. To establish the whole picture, the doctor may ask the following questions:

• Has there been an injury?
• How did the damaged area heal?
• Are there any pains and are there any other symptoms?
• What is the temperature and has it increased?
• What diseases does the patient have? Diseases of the heart and blood vessels?
• What are the sugar levels? Is there diabetes?

If you have signs of gangrene development, the following tests will be prescribed:

Treatment of dry gangrene

As mentioned above, gangrene affects areas far from the heart, suffering from impaired blood flow. First of all, these are the limbs, so let's consider how the treatment goes if the patient has dry gangrene of the lower extremities.

In order to prevent the development of the disease, at the first symptoms it is necessary to consult a doctor and begin treatment. What is the treatment?

1. At the initial stage, it is advisable to try to restore normal blood circulation.
2. Assign a vitamin complex and drugs that help improve blood circulation in small vessels.
3. Medicines that stimulate the body's immune system.
4. Antibiotics are prescribed, which will reduce the inflammatory process.
5. The application of ointments affecting the affected area is shown.
6. Perhaps the appointment of physiotherapy using infrared radiation. This will speed up tissue regeneration, stop the spread of cell death, and improve blood circulation. This treatment method is becoming more and more popular.
7. If the treatment gives good results, then the appointment of physiotherapy exercises is possible.

As a rule, the general condition of the patient does not worsen if it is dry gangrene. Treatment will continue until there is a clear line separating dead and healthy tissue. Then surgery is possible.

There are several surgical techniques that have shown their effectiveness in the fight against dry gangrene:

1. Necrotomy. During the operation, the surgeon dissects the affected tissue in order to ensure the outflow of fluid from the inflamed area.
2. Necrectomy. In this case, dead tissue is removed while healthy tissue is preserved. Such a manipulation can be performed in several visits, this allows you to save the maximum organ and tissue.
3. Resection is the removal of organs if they are affected by gangrene.
4. Amputation. Most often, this method is resorted to if gangrene affects the limbs. In order to prevent the spread of the process to healthy areas, if the treatment does not give the desired effect, the doctor makes such a decision.

If it is not advanced dry gangrene, treatment without amputation is possible. Stopping the process at the initial stage, the disease does not allow to take over a larger area. If the disease has gone too far, then, as a rule, it is not possible to save the affected limb.

A high probability of developing gangrene in elderly bedridden patients. In this case, special care and a mandatory examination for vascular patency are required.

Folk remedies for the treatment of gangrene

Folk remedies for the treatment of gangrene can be used only after consulting a doctor. It is impossible to cure gangrene using only traditional medicine, especially in a wet state. This is dangerous for your health. Traditional healers offer several recipes to alleviate the condition.

Complications of dry gangrene

Any doctor will say: if there is no appropriate and timely treatment of gangrene, then this will inevitably end in irreversible tissue damage. Since gangrenous lesions can have different localization, depending on this complication may be as follows:

To prevent such complications in the presence of suspicious symptoms that may indicate developing gangrene, it is necessary to consult a specialist. Only timely and competent treatment will stop the process and prevent complications from developing.

Forecast

For a disease such as dry gangrene, the prognosis is generally good. If you do not start the disease and do not allow the process to go into a wet form. Intoxication of the body does not occur, the general condition is normal. The dead part can itself, without surgical intervention, self-amputate. If gangrene is detected in the early stages, localization of the focus is possible, minimizing it, which does not require surgical intervention.

If we talk about the prognosis of wet gangrene, a person's life depends on its development. Infection can spread to the heart, kidneys, liver, which can cause death of the patient. Gangrene of the internal organs requires their immediate removal.

Disease prevention

In order not to develop gangrene, it is necessary to treat all diseases that can provoke tissue necrosis.

• Timely treatment of wounds according to all the rules.
• If you have a burn or frostbite, be sure to show the damaged area to the doctor, he will prescribe the appropriate treatment.
• It is necessary to treat diseases that impair blood circulation: diseases of the heart and blood vessels.
• Timely eliminate infectious diseases.
• Fight bad habits.
• Diabetics need to regularly examine the lower extremities, feet for damage, so that immediate treatment can be prescribed, since such patients have a high risk of developing gangrene.

Gangrene is a pathological process that affects various tissues of the body and contributes to their death. A variety of factors influence the development of the disease. Most often, tissue death occurs due to insufficient blood supply, the negative influence of external factors. It is possible to cure the disease, the choice of the method of therapy depends on the degree of damage and the development of the disease.

What influences the formation of gangrene?

The development of the disease is influenced by external and internal factors. External are:

• mechanical damage to tissues with violation of the integrity of blood vessels, nerves;
• physical damage: thermal injury, chemical effects on the body of various components.

The internal causes of the development of pathology are as follows:

• processes that violate the saturation of the tissues of organs and blood vessels with nutrients;
• anatomical disorders;
• reduction of blood vessels, their blockage.

Very often, people who are diagnosed suffer from the presented ailment. It is he who serves as the main factor in the development of a heart attack, thrombosis and gangrene.

How does the disease manifest itself?

Symptoms of gangrene are determined taking into account the characteristics of the affected area. Very often, patients are diagnosed with gangrene of the lower extremities. It can be of three types: wet, dry and gas.

Each of the presented forms has its own characteristic manifestations. However, experts identify the main signs of gangrene for all forms by which it is possible to recognize the disease and seek help in time. As a rule, they occur at a late stage in the development of pathology. These include:

• pain syndrome;
• tissue necrosis;
• puffiness;
• change in the color of the skin;
• decrease in blood pressure;
• development ;
• body dehydration.

Another disease is classified according to the place of its concentration. In this case, the following types of illness are distinguished:

• Fourier's gangrene (scrotum);
• lower and upper limbs;
• gangrene of the lung;
• intestinal damage;
• gangrene of the skin;
• damage to the ears and nose.

dry form

Dry gangrene is a pathological process that affects a certain part of the body and does not have the ability to spread. The first stage of the development of the disease begins with the following symptoms:

• severe pain in the area of ​​the dead vessel;
• the affected legs begin to turn pale, and the skin integuments resemble marble in color;
• there is no pulse in the affected area.

Further, dry gangrene causes a complete loss of sensation. But the pain of the patient tormented for a long time. The reason is that the nerve roots die in the affected tissues for a long time. There is a violation of the movement of blood in the main vessel, as well as in its branches.

Dry gangrene can occur due to impaired blood supply to the limbs, severe tissue dehydration. Under such conditions, tissues dry out, after which they mummify and change their color.

Dry gangrene affects the tips of the capillaries and reaches the main vein. In the area where the connection of the affected and healthy tissue occurs, a protective barrier is installed. In order for the tissue to completely die and the recovery process to begin, it is necessary to wait a very long time. With dry gangrene, cells in the affected tissues develop for a very long time. With this development of events, dead tissues do not disintegrate, and toxic components penetrate in low concentrations. For this reason, their accumulation is not the cause of intoxication.

How does the patient feel? His condition for this period is satisfactory. Such conditions make it possible to abandon the operation to remove a leg or arm, and try to wait until the protective barrier is fully formed.

wet shape

The formation of wet gangrene is preceded by the same factors as dry. However, a more rapid process of disturbing the movement of blood in the vessels is swept aside here. Wet gangrene is most often diagnosed in overweight people. Dehydration of tissues in this form of the disease occurs without a trace, so the process of decay begins to develop.

Wet gangrene causes poisoning of the body, which results in the penetration of tissue decomposition products into the body. In dead tissues, there is an active formation of bacteria, which serve as the main reason for the rapid development of the pathological process.

Wet gangrene can affect a person due to a malfunction of the internal organs. A blockage in large veins can provoke a wet form of the disease.

Symptoms of the initial stage of development of the wet form are very similar to the manifestations of the dry form. The only wet gangrene contributes to the formation of spots with blisters and purulent contents on the affected area of ​​the skin. The patient's state of health is poor, he experiences severe pain at the site of the pathology, he has low blood pressure, dryness of the tongue and a rise in body temperature.

Wet gangrene causes such a dangerous consequence as severe intoxication. Most often, it serves as a reason for development, which becomes the cause of death. Gangrene often affects when, the body's struggle with excess sugar leads to the formation of an ailment.

gas form

Gas gangrene affects various parts of the body (face, knee joint). But most of all, this disease affects the legs and arms. The disease is classified into two types: acute and atherosclerotic.

The cause of the formation of the disease can be the entry of certain microbes into the wound. Further, spores are formed in the wound, the development of which occurs rapidly if the tissue is not saturated with oxygen. This type of gangrene can form after the penetration of microbes of various nature into the wound.

Gas gangrene is characterized by the destruction of the body's muscle tissues. When it hits tissues that serve as a suitable habitat for microbes, toxic substances are released. They penetrate the connective tissues and destroy them. This process is fast paced. Microbes secrete a component that affects the breakdown of proteins and carbohydrates of damaged tissues with the release of a special gas.

This process is characterized by a slow flow. The first manifestations are pain and swelling in the area of ​​infection. In addition, a dark liquid with a nasty odor begins to stand out from the wound, and the skin acquires a dark shade. If you lightly touch the skin in the affected area, you can hear a sound resembling crackling.

Treatment of gas gangrene without surgery is impossible. During therapy, the entire affected area is removed. If the case is running, then amputation is indispensable here.

Therapy

Treatment of gangrene is a set of measures aimed at combating intoxication. Doctors pay much attention to the functioning of blood vessels and the heart, so patients are advised to infuse more fluids.

Treatment of gangrene with local methods is carried out when it is necessary to remove dead tissues and organs. For each patient, his own treatment regimen for gangrene is developed, which depends on the causes and type of pathology. If there is wet gangrene, then all forces are directed to making it dry. For these purposes, use alcohol dressings, opening blisters. Dry gangrene may result in self-amputation. But as a rule, its therapy is associated with amputation of organs and tissues by surgery.

In most cases, the disease progresses and contributes to the formation of fatal consequences. As a result, gangrene of the lung, intestines, kidneys, Fourier gangrene is formed. If there is a gas and wet form, then the development of the disease occurs very quickly, and the treatment of gangrene involves urgent amputation. The prognosis for people with diabetes is disappointing.

Effects

The presented disease is very serious, as it can contribute to the formation of very serious complications. If there was gangrene of the abdominal cavity, then a serious condition arises, which can only be eliminated by surgery.

Gangrene of the lung causes sepsis, insufficient work of the cardiovascular and respiratory systems in an acute form. With a dry form of foot gangrene, a transition to a wet one can be observed if adequate therapy is not carried out. Wet gangrene can be complicated by poisoning of the body and sepsis, which will lead to the death of the patient. All of these complications require immediate medical attention. Self-treatment is prohibited.

Preventive actions

If you do not want to hear from the doctor such a terrible diagnosis as gangrene, then it is necessary to treat the underlying disease in a timely manner. These include the following diseases:

• systems of the heart and blood vessels;
• abdominal organs;
• thermal injury.

If there are acute conditions characterized by a violation of the movement of blood through the vessels, then it will be necessary to take measures aimed at restoring the vessel. By following the measures presented, it will be possible not to worry about gangrene. As a rule, it occurs in those people who do not take their health seriously.

If it was not possible to escape from the disease, then you should not immediately panic. Many people suffering from gangrene have successfully recovered and do not even remember what happened. But at the same time, the danger that pathology entails cannot be ruled out. Just watch your health and treat all diseases in a timely manner.

Very scary word "gangrene"! And it sounds scary, and the disease itself is fraught with great danger to human health and even to his life. A diagnosis of gangrene means that cells in the body are dying. They die either in tissues (skin, subcutaneous tissue, muscles) or in internal organs (intestines, lungs, etc.). But the tissues most often affected by the disease are those that are located farthest from the heart, which means that they are less provided with blood and oxygen. These are, first of all, the limbs: gangrene can affect the hands and especially the lower limbs - the legs.

Gangrene is nothing more than the death of body cells

Symptoms of gangrene

Symptoms of gangrene of the lower extremities are easily detected: the legs quickly get tired and freeze even in summer, they often get cramps, and the fingers become numb and lose sensitivity. The skin on the legs may become "waxy", then bluish, greenish, purple or even black. If nothing is done, then wounds that cannot be healed may appear. All these are signs of incipient gangrene - the death of tissue cells. And this, of course, can and should be fought. The main thing is that the sooner treatment is started, the greater the chances of recovery.

Causes

The causes of gangrene can be divided into three groups.

1. Insufficient supply of blood vessels, and hence tissues, with blood and oxygen. This happens when the blood vessels are clogged, affected (atherosclerosis, diabetes, varicose veins).

Types of gangrene

Gangrene is distinguished by several factors:
- according to the appearance of the dying tissue and its consistency: dry or wet;
- for reasons of occurrence (infectious, allergic, traumatic, etc.);
- according to the method of manifestation (lightning, gas, hospital).

Dry gangrene is most susceptible to extremities. Very slow (over months and even years), gradual blockage of blood vessels, first of all, is reflected in the fingers and feet - they start to get very sick, become insensitive, can swell, turn pale, and then mummify (brown, thin, dry out). The living area is separated from the dead by a sharp border. The person feels normal, since the spread of death does not occur. Surgical intervention is possible only at the request of the patient for cosmetic purposes.

Extremities most susceptible to dry gangrene

The development of wet gangrene, unlike dry gangrene, occurs very quickly (the count goes to days). The constant presence of infection in the affected area of ​​the skin does not allow it to dry out, the tissue rots and decomposes “before our eyes”, infects healthy areas, more and more poisoning the body, resulting in intoxication, body temperature rises. External infected areas swell, turn blue, blacken, exude a putrid smell. At this stage of the disease, amputation of the damaged organ is indicated, since human life is in danger.

One type of wet gangrene can affect the tissues of the face and oral cavity. Infection can penetrate into the internal organs (gangrene of the lung, gangrene of the intestine) or spread to the genitals (Furnier's fulminant gangrene), the kidneys and liver begin to fail. Gangrene of the intestine is manifested by peritonitis and is always wet. Gangrene of the lung causes severe intoxication. The patient coughs up fetid sputum.

Infectious gangrene occurs due to infection of the skin with streptococci, staphylococci, diphtheria and other bacilli. This is how Fournier's fulminant gangrene of the genital organs develops, skin gangrene in young debilitated children who have had infectious diseases, gangrene in adults suffering from acute or chronic infectious diseases (tuberculosis, syphilis).

Gas gangrene is provoked by soil and "street" bacteria that enter open cutting or stab wounds, from there into the muscles, where they multiply very quickly and become toxic to the body. The patient's temperature rises sharply, pressure jumps, arrhythmia begins, nausea appears. The infected area swells, the muscle tissue begins to rot. Gas gangrene is diagnosed by tapping on the affected area with a metal object (crunching sound) and removing a cotton swab from the wound (popping sound).

With gangrene, the leg often cramps

Treatment of gangrene

Dry gangrene can sometimes not turn into wet gangrene, heal itself. But this rarely happens. Usually this does not happen, and gangrene actively develops, causing deadly complications in the kidneys, lungs, liver, heart, blood and other vital organs.

Wet and gas gangrene develop very quickly and usually end in amputation. Gas gangrene can also be complicated by the occurrence of hemolytic anemia, a very life-threatening blood disease.

Gangrene of the abdominal organs is fraught with peritonitis, which is stopped exclusively by surgery.
Gangrene of the lung very quickly turns into pulmonary bleeding and threatens with cardiovascular insufficiency.
The foregoing convinces of the need to consult a doctor already at the first symptoms of gangrene and in understanding the seriousness of the situation and the inadmissibility of self-treatment.

Dry gangrene can do without surgery

Before proceeding with the treatment of any type of gangrene, it is necessary to be examined, make a correct diagnosis, and identify the cause of the disease. The comprehensive examination includes the following tests:
- blood for sugar;
- blood for biochemistry;
- examination of the affected skin;
- x-ray examination,
– tomographic examination;
- arteriogram.

As soon as the type of gangrene and the cause of its occurrence are determined, doctors begin actions to eliminate the factors that led to the disease, disinfect infected areas and prevent the spread of the decay process.

If dry gangrene is diagnosed, regular manipulations with a disinfectant solution (iodine, brilliant green, others), quartzing of the affected area and the area around it begin. They carry out measures to restore the function of blood vessels and stop infectious processes, for which antibiotics are attributed. Dead skin areas are removed.

Having diagnosed wet gangrene in the initial stage, they carry out a blood transfusion, remove dead tissue, restore the functions of vascular conduction, and try to turn it into dry. With the advanced form of the disease, urgent amputation of the limb is prescribed.

With gangrene of the abdominal organs and gas gangrene, operations are performed to remove the diseased organ and clean the wound in order to avoid general blood poisoning.

It should be noted that until quite recently, any gangrene unequivocally implied amputation of the affected limb. Everything has changed today. Modern surgery saves diseased limbs from amputation in 90% of patients with gangrene of the fingers and feet.

Microsurgeons, using unique micro-instruments, restore vessels “clogged” with plaques, cleaning and expanding them to normal sizes. The blood begins to “run” normally through the vessels and supply oxygen to the tissues of the body.

Today, in the fight against gangrene, resonant infrared therapy is becoming increasingly popular among physicians, which improves the blood supply to the diseased tissue, relieves pain and swelling, and restores normal skin color.

Gas gangrene requires surgery

Disease prevention

Prevention of gangrene of any kind is the elimination and prevention of the causes of necrosis, the observance of a healthy lifestyle, the timely removal of dead tissues in order to prevent their spread. What needs to be done for this?

- Quit smoking.
- Throw all your strength into lowering blood cholesterol levels. To do this, you need to choose the necessary medications with the help of a doctor and take them regularly. It is also necessary to review your diet: reduce the consumption of protein foods, fatty, spicy, smoked and salty foods, exclude the use of alcohol and sugary drinks with gas. At the same time, enrich your diet with blood-thinning foods such as citrus fruits (oranges, lemons), pomegranates and pineapples, ginger and figs, currants, garlic. Pumpkin and flax seeds, walnuts and pine nuts, fatty fish with Omega-6 polyunsaturated fatty acids, vegetable oils (linseed and olive), whole grain cereals, bran bread, green vegetables and fruits are also useful.
- Physically load yourself (charging, walking, swimming, etc.).
- Regularly see a doctor with a tendency to vein thrombosis.
- Diabetics need to constantly monitor their blood sugar levels, protect their limbs from injuries, frostbite and other damage, do gymnastics for the feet. To prevent gangrene and increase immunity, people prone to diabetes are advised to drink tea with nutmeg daily and eat aloe leaves.

Subject to these simple rules, there is a high probability of non-spread of the onset of gangrene to healthy tissues.

Folk remedies for gangrene

A great help in the treatment of the initial stage of gangrene in diabetes mellitus can be traditional medicine with its centuries-old proven folk methods of dealing with this disease. What are the folk remedies that help to cope with the onset of gangrene?

1. A piece of rye bread with salt, carefully chewed and soaked in the enzymes of one's own saliva, is applied in a plentiful layer on the affected area of ​​the skin and fixed with a bandage.

2. Sterile gauze or cloth is soaked in fresh curdled milk and tied to the site affected by gangrene.

3. Collected and dried juniper leaves are ground into a powder and used as a powder on wounds.

4. An effective remedy for incipient gas gangrene is clove oil. Clove oil, known for its antibacterial properties, is soaked in a clean cloth and applied to the affected area. Also, its solution is taken orally (3-5 drops per 50 ml of water).

Rye bread - one of the folk remedies for the treatment of gangrene

5. If gas gangrene has spread to the internal organs, you should drink oxalic juice and apply oxalic gruel to sore spots.

6. A mask of half red clay and half chopped onion, diluted with a small amount of vinegar, is applied to the area of ​​pain and aged until completely dry.

7. A very effective way to treat gangrene is to apply a piece of beef or other liver with blood to a fresh wound. The liver, bandaged to the site of the gangrene lesion, is kept until the wound is bubbling with abscesses. Then you need to take a sterilized needle and pierce all the bubbles. This should be done until abscesses no longer appear under the liver.

8. Prepare a mixture of equal parts of melted lard, honey, laundry soap, rosin and vegetable oil. Melt it all, boil, then cool. Add chopped garlic cloves, onion and aloe leaf (1:1:1). Lubricate the wounds with a warm prepared ointment.

9. Boiled sprigs of willow and willow are applied to pre-washed with a solution of a disinfectant (furatsilina, for example), they are fixed with a bandage and left overnight. After removing the bandage, the area affected by gangrene is smeared with fresh honey.

10. Applying to the diseased area a compress prepared from lily flowers with stems infused for two weeks in unrefined sunflower oil. The healing compress is kept for three hours, then the wound is washed with a disinfectant solution (furatsilin, potassium permanganate) and the compress is applied again.

11. If gangrene has developed after frostbite, it is recommended to take inside a mixture of oak bark powder (5 teaspoons), ground gravilate root (1.5 teaspoons), ammonia salt (1 teaspoon). The well-mixed medicinal ingredients are divided into eight servings and taken throughout the day every two hours. It is necessary to drink the drug with an infusion of viburnum bark, wild chestnut, gravilate root and boldyryan (officinalis valerian). To prepare the infusion, take 4 teaspoons of each medicinal component and pour the mixture with a liter of boiling water, insist.

These are the most famous and tested by thousands of suffering people folk methods and recipes for dealing with various types of gangrene. Do not give up, you need to try any means to get rid of this terrible disease.

Well, if nothing helps, the disease progresses, so in the name of saving life, without wasting precious time, you must boldly go for an operation. Be healthy!

Video

Thanks

Gangrene- this is the death of body tissues that have a connection with the environment, while the body acquires a dark, black color. The disease is characterized by a severe course, threatens with the loss of an organ and is life-threatening for the patient.

Gangrene was very common before the invention of antibiotics and various methods of instrumental and laboratory diagnostics, especially during wars. Most of the wounds of the limbs ended in their loss. Also, gangrene often developed in a hospital setting, as a postoperative complication and the result of a nosocomial infection.

In our time, when a huge number of antibiotics are available, this disease is also not uncommon. Thus, according to statistics, more than half of patients with insulin-dependent diabetes mellitus develop gangrene of the lower extremities within 20 years.

Interesting Facts!

Reasons for the development of gangrene

Circulatory disorders ("ischemic gangrene"), most often develops in older people:

• Diabetes mellitus is the most common cause of gangrene, with the lower extremities most often affected, namely the feet.
• Atherosclerosis - in the obliterating form of the disease, an atherosclerotic plaque can completely block the lumen of the vessels, preventing the flow of blood to the organ.
• Obliterating endarteritis is an autoimmune vascular disease that often develops in heavy smokers.
• Overlapping of blood vessels by a thrombus, while the thrombus can come off after operations, bleeding, childbirth.
• Thrombophlebitis of the lower extremities.
• Raynaud's disease is a syndrome of many diseases in which the innervation of blood vessels is disturbed (systemic lupus erythematosus, scleroderma, severe cervical osteochondrosis).
• Myocardial infarction, ischemic stroke, pulmonary infarction and other diseases.

• Frostbite of limbs;
• burns;
• electric shock, including lightning.

• Injuries and injuries in which the integrity of blood vessels and nerves is violated - a gunshot wound, a wound from shell fragments, an accident, and so on;
• bedsores of bedridden patients;
• state after "unsuccessful" operation;
• prolonged squeezing of an organ - being under rubble, in a car after an accident, prolonged application of a hemostatic tourniquet or tight plaster bandaging, wearing narrow rings, shoes, pulling unusual objects on the penis, infringement of a hernia, and so on.

• Anaerobic gas gangrene - the causative agent is anaerobic bacteria Clostridia;
• Purulent diseases caused by staphylococci and streptococci: lung abscess, purulent appendicitis, peritonitis, etc.;
• proteus;
• meningococcal infection (meningococcemia);
• tuberculosis (with caseous pneumonia, pleural empyema);
• leprosy or leprosy, and others.

Dry gangrene is the result of prolonged circulatory disorders under aseptic (without infection) conditions. This type of gangrene leads to the mummification of the affected area, which over time can detach from the body (amputate). Dry gangrene mainly affects the extremities. Often both limbs are affected, symmetrically. In most cases, dry gangrene does not threaten the life of the patient until the infection has joined.

Wet gangrene is always a threat to the patient's life, as an infection is involved in the process. Gangrene of the extremities, genitals, lungs, intestines and other internal organs proceeds according to this type.

Types of gangrene depending on the cause of development

• Ischemic gangrene;
• infectious gangrene;
• anaerobic gas gangrene;
• toxic gangrene;
• allergic gangrene;
• hospital gangrene (developing in the hospital, for example, after surgical interventions).

ICD-10

• Gas gangrene - A 48.0;
• Gangrene associated with atherosclerosis - I 17.2;
• Gangrene in diabetes - E 10.5 - E 14.5;
• Dry or wet gangrene of the extremities - R 02;
• Gangrene of the intestine - K 55.0;
• Gangrene of the lung - J 85.0;
• Gangrene of the tooth - K 04.1;
• Gangrene in Raynaud's disease - I 73.0.

How does gangrene develop? (pathogenesis)

Stages of development of wet gangrene
1. Acute cessation of blood supply to an organ (trauma, thrombus, frostbite, etc.).
2. The rapid development of tissue necrosis, sometimes lightning fast, within a few hours.
3. The accession of infection, the development of an infectious inflammatory process.
4. Rapid decomposition of dead tissue (rotting): swelling, pain, darkening, increase in the volume of the affected area.
5. Immune reaction - immunity cannot limit necrosis from healthy areas, infection spreads and a large amount of toxins enter the bloodstream.
6. Toxins of bacteria and destroyed tissues, getting into the blood, worsen the general condition and lead to disruption of the work of all organs and systems of the body. At this stage, in addition to toxins, bacteria can also enter the blood - sepsis (blood poisoning) develops. Sometimes a few hours pass before the development of multiple organ failure (failure of vital internal organs), this threatens the life of the patient.

Why does gangrene have black skin?
Firstly, blood does not flow to the affected area, namely, it gives a pink color to our skin. Secondly, decay products accumulate in tissues, including hemoglobin (a blood protein that carries oxygen and carbon dioxide). The iron in it binds with sulfur, which is released from the destroyed tissue of the skin, muscles, and nails. Salt iron sulfide in the absence of oxygen has a black metallic color.

Symptoms and signs, photo

First signs. How does gangrene start?

• The heat exchange of the skin is disturbed, it becomes cold to the touch;
• the sensitivity of the skin is disturbed, there is a feeling of numbness in the affected area;
• there is weakness, fatigue;
• movements and their coordination are disturbed; if it concerns the lower extremities, lameness appears; if the upper limbs, then everything falls out of hand;
• pain and burning appear in the affected areas.

A photo: signs of circulatory disorders of the fingers, Raynaud's syndrome.

Symptoms of dry gangrene of the extremities

• With the development of dry gangrene, fingers, hands or feet first acquire a bright red color or, conversely, their cyanosis occurs;
• then the skin becomes pale, an unhealthy shine appears, marbling, the skin gradually darkens, acquiring a bluish tint, then completely blackens;
• all skin changes with dry gangrene develop from the peripheral parts to the center, to the place of cessation of blood circulation;
• a clear boundary is visible between the area of ​​gangrene and a healthy area - the contrast between black and pink skin, a seal is also determined - a demarcation roller or demarcation shaft;
• the affected limb is reduced in size, deformed;
• unlike wet gangrene, there is no putrid smell;
• the pain stops and some sensitivity in the affected limb disappears altogether;
• there is also no pulse;
• with injury and infection of the affected limbs, dry gangrene can become wet, but in most cases this occurs in the initial stages of the disease, when the affected limb has not yet completely dried up.

Symptoms of wet gangrene of the extremities

• The skin becomes pale, a vascular network of dilated veins appears;
• swelling of the affected area appears, due to which it increases in size;
• there are no boundaries between the gangrenous and healthy areas, gangrene can spread to other areas;
• brown blisters form (due to filling with blood), which quickly open, and in their place wounds form - trophic ulcers that have a dirty gray color;
• when pressing on the bubbles, a characteristic crunch is heard - this is an accumulation of hydrogen sulfide - a product of the breakdown of soft tissues and muscles;
• foul-smelling rot exudes from the ulcer;
• all these manifestations are accompanied by a violation of the general condition, which is associated with intoxication by the decay products of bacteria and necrosis of one's own tissues.

Features of pain in gangrene

Pain stops only after complete necrosis of the limb, that is, after its complete blackening. In some patients, after the complete death of the limb, phantom pains may appear - pain in the limb, which is not present (after amputation), scientists still cannot explain this phenomenon. Phantom pain is almost impossible to stop.

For wet gangrene the pain appears suddenly, it is acute and also does not stop after taking strong analgesics. There is an opinion that after the onset of pain due to circulatory disorders, the patient and the doctor have only a few hours to prevent the death of the organ. With the appearance of ulcers and decay of a limb or organ, pain in most cases does not stop, which is associated with the spread of decay to other areas.

Temperature and intoxication

But with wet gangrene, intoxication is gaining momentum, the general condition of the patient is deteriorating sharply, severe. In rare cases, wet gangrene occurs without severe symptoms of intoxication, but this does not indicate an easy course of gangrene and a good prognosis.
Symptoms of intoxication in a patient with wet gangrene:

• an increase in body temperature to high numbers, sometimes up to 40-41 o C;
• severe chills, tremor of the limbs;
• palpitations, more than 90 per minute;
• drop in blood pressure below 90/60 mm Hg. Art.;
• severe weakness, the patient cannot get out of bed;
• possible confusion, delirium, convulsions;
• with severe intoxication and the development of sepsis, other organs are also affected: the brain, kidneys, liver, heart, lungs, blood vessels, blood clotting disorders occur - bruises and bruises appear, the patient may die from multiple organ failure (failure of vital organs).

Features of the course of some forms of gangrene

Anaerobic gas gangrene

The genus Clostridia includes the causative agents of botulism and tetanus. All these bacteria secrete the strongest poisons - toxins.

Microbiology Clostridia

Features of the course of gas gangrene:

• it is always wet gangrene;
• the presence of large blisters containing blood and gases formed during the life of clostridia;
• when pressing on the skin, a special crunch is heard;
• always severe intoxication;
• very fast and progressive.

Forms of gas gangrene:
1. Emphysematous form - characterized by increased formation of gas-containing bubbles, sometimes their sizes reach sizes of more than 10 cm in diameter.
2. Edema-toxic form - edema of the affected organ and intoxication predominate, blisters of small sizes, single.
3. mixed form- this is a combination of clostridia with coccal infection (staphylococci, streptococci). This form is especially severe, characterized by rapid putrefactive processes and the spread of infection over large areas.

Fournier's gangrene

Necrosis of the scrotum proceeds according to the type of wet gangrene due to tissue infection with various bacteria. Gangrene usually occurs after an injury to the external genitalia.

Symptoms of fulminant gangrene of the scrotum:

• pain, redness, swelling in the scrotum;
• increased pain syndrome;
• the skin of the scrotum becomes black;
• ulcers appear with purulent discharge;
• severe intoxication.

Gangrene of the intestine

Symptoms of intestinal gangrene:

• sudden onset;
• sharp, intolerable abdominal pain;
• weakness;
• blood pressure drops below 90/60 mm Hg. Art.;
• increased heart rate above 90 per minute;
• thready pulse;
• possibly a violation of consciousness, up to its loss;
• vomit;
• diarrhea or constipation, stools may contain blood;
• when listening to peristalsis (motility) of the intestine, you can hear a pulsation in the abdomen;
• after 2 hours, the symptoms of intoxication intensify.

A photo: this is how intestinal necrosis looks like with thrombosis of mesenteric vessels.

Gangrenous cholecystitis

Symptoms of gangrenous cholecystitis:

• usually acute onset;
• severe pain in the abdomen, which can radiate to the chest, under the shoulder blade, to the lumbar region, to the right shoulder, the pain intensifies in the position on the right side;
• pronounced symptoms of intoxication: temperature over 39-40 o C, severe weakness, headache, and so on;
• nausea and vomiting not associated with food intake;
• bloating;
• on examination, there is a sharp pain in the right hypochondrium.

Gangrenous cholecystitis also requires urgent surgery, threatens the development of purulent peritonitis and sepsis.

Gangrenous appendicitis

Symptoms of gangrenous appendicitis:

• usually gangrene of the appendix occurs 2-3 days after the onset of symptoms of acute appendicitis;
• pain in the left iliac region, which is characteristic of acute appendicitis, subsides;
• severe vomiting begins, which exhausts the patient, blood may be present in the vomit;
• symptoms of intoxication are expressed (a serious condition of the patient, an increase in heart rate, a decrease in blood pressure), but at the same time the body temperature is normal, this is a characteristic syndrome for gangrenous appendicitis - "toxic scissors syndrome".

Gangrenous appendicitis requires urgent removal of the appendix, as it threatens the development of peritonitis, sepsis, and intestinal gangrene.

A photo: remote appendix with gangrenous appendicitis.

Abscess and gangrene of the lung

Causes of gangrene of the lung:

• pulmonary embolism (TELA) - blockage of the pulmonary vessels by a thrombus;
• lung abscess - a purulent disease, a complication of bacterial pneumonia;
• penetrating gunshot or stab wounds into the chest cavity, fracture of the ribs with displacement of fragments;
• foreign bodies in the bronchi, including aspiration of vomit;
• purulent pleurisy;
• sepsis - infection through the blood or septic pneumonia;
• pulmonary tuberculosis: caseous pneumonia, fibrous-cavernous tuberculosis, pleural empyema.

Symptoms of gangrene of the lung:

• the development of gangrene of the entire lung is possible, since necrosis spreads very quickly to healthy tissue, but there are cases of bilateral total gangrene, this condition is incompatible with the life of the patient;
• sharp sharp pains on one side of the chest, aggravated by deep breathing and any movement, coughing, sneezing and even talking;
• severe shortness of breath - difficulty inhaling and exhaling;
• intense symptoms of intoxication, the patient's condition is severe and extremely severe;
• agonizing cough with sputum dirty dark color, having a fetid putrid odor;
• possible hemoptysis or pulmonary bleeding;
• the skin becomes sharply pale, cyanosis of the skin of the face and extremities is observed;
• symptoms of heart failure appear (low pressure, increased heart rate, swelling, and so on);
• possible development of infectious toxic shock (drop in blood pressure, lack of urine, the appearance of rashes and bruises).

Diagnostics

Laboratory research methods for gangrene

Instrumental research methods for gangrene

Complications and consequences of gangrene

Spread of gangrene over large areas
With untimely treatment of wet gangrene, necrosis quickly spreads to healthy tissues. So, if the foot is affected, gangrene up to the level of the knee can develop in a few days. This increases the risk of other, more severe complications, including sepsis.

Sepsis, or blood poisoning
Sepsis can occur with wet gangrene, while bacteria and their toxins massively enter the bloodstream and spread throughout the body. This condition threatens the life of the patient, the patient may die from toxic shock, cerebral edema, or septic endocarditis (heart damage).

The main signs of developing sepsis:

• high fever;
• drop in blood pressure;
• the appearance of rashes all over the body in the form of bruises;
• convulsions;
• violation of the heart rhythm and breathing;
• confusion or loss of consciousness and other symptoms.

Amputation of limbs
With dry gangrene, the limb dries up (mummifies) and over time can “fall off” on its own. But more often, surgical amputation occurs, which is carried out in order to save the patient's life.

The transition of dry gangrene to wet
Dry gangrene, especially at the onset of the disease, may be complicated by the addition of bacterial flora. This is manifested by the presence of intoxication and the spread of gangrene to overlying tissues, that is, the boundary between dead and healthy tissues ceases to be determined.

Peritonitis and intestinal obstruction
This complication often develops with gangrene of the intestine, appendix and gallbladder. In this case, the infection from the affected organs passes to the serous membrane of the abdominal cavity. This condition without surgical treatment can lead to the death of the patient.

Treatment

It is not easy to cure this condition. Treatment is always complex, aimed at saving the patient's life, the cause of the development of gangrene, restoring blood circulation and preventing the spread of the process.

The amount of treatment directly depends on the type of gangrene.

Treatment of dry gangrene

• intravascular (endovascular) operations;
• shunting and stenting of clogged vessels;
• amputation of dead tissues - the affected limbs are routinely removed above the line of demarcation from healthy tissues.

Treatment of wet gangrene

Treatment of gas gangrene

Treatment of gangrene of the lung, intestines, gangrenous cholecystitis and appendicitis

• Antibiotics intravenously and intramuscularly.
• The introduction of antibiotics and antiseptics into the bronchi using a bronchoscope.
• Detoxification therapy - intravenous drip of solutions.
• Drugs that dilate the bronchi: inhalations of Salbutamol, Ventolin, Berodual, Eufillin injections.
• Drugs that increase immunity.
• Surgical treatment: removal of part or amputation of the entire lung during the formation of a lung abscess (abscess), freeing the pleural cavity from pus. Surgical treatment is resorted to only in the absence of the effect of drug therapy.

• urgent surgical removal of the affected area of ​​the intestine;
• antibiotics.

• surgical removal of the affected organ;
• antibiotics.

Use of antibiotics

Considering that during tissue necrosis, not one type of bacteria is usually present, but a whole spectrum, antibiotics should act on all possible microorganisms, therefore, not one antibiotic, but two or even more is often prescribed. The drugs are administered in the form of intravenous or intramuscular injections, while using the maximum dose. Recently, the method of introducing antibiotics into the lymphatic plexuses and vessels has proven itself well.

The most commonly used antibacterial drugs to treat gangrene are:

• The use of painkillers

  Painkillers are used for any type of gangrene, as patients are worried about unbearable pain. But, unfortunately, even narcotic drugs are not able to alleviate the suffering of the patient, as surgeons joke: "The best painkiller is amputation."

  Types of pain relief for gangrene:
  1. Narcotic drugs (Morphine, Tramadol, Omnopon) - a good short-term effect, but their use can develop drug dependence, especially with long-term use.
  2. Non-narcotic painkillers (Analgin, Ibuprofen, Dexalgin) - have a very weak and short-term effect.
  3. Novocaine blockade - the affected areas are chipped with novocaine. This method not only reduces the intensity of pain, but also dilates the vessels, improving their patency.
  4. Epidural anesthesia - the introduction of anesthetics into the spinal canal. Suitable for gangrene of the lower extremities and scrotum.
  5. Physiotherapy - neurostimulation of the spinal nerves.

  Ointments for gangrene

  In traditional medicine, ointments are rarely used to treat gangrene, as they can not only not help, but also harm.

  Of those used, ointments containing antibiotics or antiseptics can be distinguished. This is Vishnevsky's ointment, Levomekol, Iruksol, Solcoseryl. But these ointments cannot be used alone, they can help in combination with other treatments.

  Surgical operations for gangrene, the main types

  1. Endovascular (intravascular) operations: aimed at restoring the patency of the blood vessel:
  • Thrombolysis is the removal of a blood clot blocking a vessel.
  • Stenting is the installation of a special device - a stent - into the lumen of a narrowed vessel, which becomes a kind of frame for it, through such a vessel the blood circulates freely.
  • Bypass is the creation of an artificial vessel through which blood can circulate around the clogged vessel.
  • Vascular prosthetics - replacement of a non-functioning vessel with an artificial prosthesis or transplanted vessel.
  2. Necrectomy- excision and removal of "dead" tissues, can only be used for shallow necrosis of the skin and soft tissues. This operation allows you to save the limb, but increases the risk of complications.
  
  3. Amputation of a limb- removal of the limb above the affected areas, followed by the formation of a stump. Amputation is necessary with rapidly progressing gangrene, the absence of the effect of other methods of treatment, is carried out according to vital indications. After the complete formation of the stump, limb prosthetics are possible.

  Is it possible to cure gangrene of a limb without amputation?

  Half of patients with gangrene undergo amputation of the affected organ. Amputation is not a whim of the surgeon, but a life-saving event, this is the last thing a doctor resorts to when nothing else helps. It can be avoided with a timely visit to the doctor, with a good response to the drug treatment, as well as the elimination of factors that impair blood circulation in the affected organ.

  How to cure gangrene at home? Folk methods of treatment

  Gangrene is not treated at home, as this disease threatens the patient's life. Every hour counts, the longer the time of inactivity, the higher the amputation rate. There is no time for experiments with herbs and other traditional medicines.

  Traditional medicine will come to the rescue in combination with other traditional methods of treatment, but these should be means that increase the body's defenses, containing useful substances, vitamins and trace elements.

  Gangrene of the leg (diabetic foot): surgical treatment without amputation - video

  Forecast

  Prognosis for dry gangrene relatively favorable, since such necrosis does not threaten the patient's life. Although, if we consider the ability to work, then of course dry gangrene leads to loss of limbs and disability. In addition, dry gangrene may develop over time on the second limb, in a symmetrical area.

  For wet gangrene half of the patients are left without a limb, while an amputation is performed significantly higher than the affected segment. There is also a very high risk of developing sepsis and death of the patient, especially with a late start of adequate treatment.

  It is not possible to restore dead tissue, so the goal of treatment is to stop the process and prevent the development of complications.

  How many live with gangrene?

  Dry gangrene does not affect the duration of life and rarely causes the death of the patient. However, the patient may die from diseases that caused the development of gangrene, for example, from obliterating atherosclerosis, heart attack, stroke.

  With wet gangrene without treatment, a person can last three days or even less. So every hour counts.

  Prevention of gangrene

  1. Proper nutrition, an active and healthy lifestyle - prevention of atherosclerosis and other vascular diseases.
  2. Timely treatment of diseases that impair blood circulation, full rehabilitation after strokes and heart attacks.
  3. Prevention and adequate treatment of diabetes mellitus, timely initiation of insulin therapy.
  4. Mandatory treatment of various wounds.
  5. Avoid burns and frostbite of extremities.
  

  Answers to frequently asked questions

  Gangrene in diabetes mellitus. What are the features of sugar gangrene?

  Diabetes mellitus is one of the main causes of gangrene. Most often, wet gangrene develops, since "sweet blood" is a good breeding ground for many bacteria. For the same reason, the treatment of sugar gangrene is always difficult and in most cases leads to amputation of the limb.

  In diabetes, the most typical gangrene of the foot is diabetic foot, the most severe complication of diabetes.

  Why does diabetic foot develop with diabetes?

  1. Angiopathy- in diabetes, excess sugar eventually damages and destroys the wall of small arteries and arterioles, which leads to impaired blood circulation and oxygen deficiency of body tissues. In addition to the foot, the vessels of the retina and kidneys are often affected.

  2. Reduced skin sensitivity Sugar also negatively affects the nervous system. Diabetics often do not feel cold, heat, pain, patients can grab a hot pan and not understand it. Therefore, with the onset of circulatory disorders, they have no symptom of pain, which leads to a later visit to the doctor.

  3. Diabetes disrupts all types of metabolism , including fat, that is, diabetics often suffer from atherosclerosis even at a young age.

  4. Immunity is reduced in diabetes , therefore, various bacterial infections are often observed, microbes do well in a sweet environment.

  5. The triggers for the development of diabetic foot are:

  • wearing narrow shoes;
  • frostbite - diabetics often do not feel cold;
  Chlorhexidine, Furacilin and others).
  7. Surgery:
  • Intravascular operations aimed at restoring blood flow (thrombolysis, stenting, shunting).
  • In the presence of a threat to the life of the patient and the absence of the effect of therapy, amputation of the foot above the level of the lesion is indicated.
  Prevention of gangrene in diabetes mellitus:
  The main prevention of diabetic foot is to control and maintain normal blood sugar levels. It is also important to pay attention to the condition of your limbs and consult a doctor in a timely manner when the first signs of circulatory disorders appear.

  Is gangrene contagious and what are the modes of transmission?

  Wet gangrene is always an infectious process. Therefore, the logical question would be: "Is it contagious?". In fact, gangrene cannot be contracted from a patient. For this to happen, the contact person must have other conditions for the development of necrosis: a wound and circulatory failure.

  The literature describes cases of outbreaks of gas gangrene in surgical hospitals. But in such departments there are people with various wounds, and clostridia can be found in the environment, there are, in fact, a lot of them.

  Do children have gangrene?

  Unfortunately, gangrene also occurs in children, but less frequently than in adults. In most cases, this is gas gangrene, which can develop after injury or surgery. Gangrenous appendicitis and gangrene associated with meningococcal sepsis are also common.

  In poor countries (especially in Africa), where children are undernourished and have poor sanitation, gangrene of the face or Noma is quite common. The causes of this pathology are not yet fully understood. Such children need plastic surgery of the face and structures of the oral cavity.

  Gangrene in a child can develop after prolonged compression of the limbs as a result of an accident or other accidents.

  Other types of gangrene associated with circulatory disorders are practically not found in children.

  Interesting! It is extremely rare for children to develop bedsores, even if they lie in bed for a long time.
  

  Before use, you should consult with a specialist.

Gangrene- this is the necrosis of body tissues that are in contact with the external environment (skin and tissues located under it, trachea, bronchi, lungs, intestines, appendix, gallbladder). In this case, the affected tissue becomes black, brown or dark blue.

Facts about gangrene:

• The black color is due to the fact that hemoglobin accumulates in the zone of necrosis, from which iron is released and turns into salt - ferrous sulfate. This compound is what gives color.
• Most often, gangrene develops in areas of the body that are most distant from the heart - the tips of the fingers and toes. This is due to the fact that the blood to the areas is forced to travel a longer path, blood flow disturbances are more likely.
• Any diseases of the heart and blood vessels increase the risk of developing gangrene, as this disrupts blood flow in remote parts of the body. Therefore, most often gangrene occurs in people with cardiovascular pathology, the elderly.
• The first descriptions of gangrene can be found in the works of ancient doctors - Hippocrates and Celsus. They also offered their own methods of treatment.
• The name of the pathology comes from the Greek word graino, which literally translates as “gnaw”. The old name for gangrene is Antonov's fire.
• Before asepsis and antiseptics were introduced, there was hospital (hospital) gangrene, which had a severe course. Often, entire epidemics of this form of the disease broke out in hospitals.

Features of anatomy, blood supply and innervation of the arms and legs

• From the aorta, the largest artery originating from the heart, the right and left subclavian arteries depart from the right and left.
• Reaching the axillary fossa, the subclavian artery passes into the axillary.
• From the axillary artery departs the brachial, blood supply to the muscles and skin of the shoulder, the humerus.
• In the region of the elbow joint, the axillary artery splits into two branches: the ulnar and the radial.
• In the region of the hand, on the palmar and dorsal sides, the radial and ulnar arteries join to form arches. From these arches arteries depart to each finger, which then break up into capillaries.
• The outflow of blood from the arm occurs in the superior vena cava.

• Reaching the lower abdomen, the aorta - the largest artery in the body, originating from the heart - is divided into two iliac arteries: the right and left.
• The right and left iliac arteries descend into the pelvis, where they each divide into the internal and external iliac arteries.
• The internal iliac artery, as its name implies, remains inside and supplies blood to the pelvic organs. And the outer descends to the lower limb.
• In the thigh area, the external iliac artery passes into the femoral. Here she gives off branches that supply blood to the skin, muscles, and femur.
• In the region of the knee joint, in the popliteal fossa, the femoral artery passes into the popliteal.
• The popliteal artery then divides into two branches, the anterior and posterior tibial arteries. They give off small branches that supply blood to the lower leg, tibia and fibula.
• Then, on the foot, the terminal sections of the tibial and peroneal arteries are connected, forming vascular arches, from which the arteries depart to the toes.
• The outflow of blood from the lower extremities occurs through the system of superficial and deep veins into the inferior vena cava.

Classification of gangrene

Dry gangrene

Wet gangrene

Most often, dry gangrene develops as a result of a gradual increase in circulatory disorders over a long time. The soles of the feet are usually affected. The body's defenses have time to work: the affected area is clearly demarcated from healthy tissues. It acquires a black or dark brown color, as if "dries out", decreases in volume. Dry gangrene is not life-threatening: the affected tissue practically does not disintegrate (it simply loses fluid and “dries out”, mummifies), therefore toxic substances are formed slowly and in small quantities - the body has time to inactivate them; the focus of tissue necrosis is clearly delimited.

Wet gangrene usually develops quickly. Almost always, wet gangrene is the result of an infection. Decay begins: the affected area swells, increases in size; the skin acquires a bluish, dark purple color; tissue degradation occurs. The body's defenses do not have time to delimit the site of necrosis from healthy tissues. Toxic substances formed as a result of cell decay enter the bloodstream in large quantities, are not inactivated, poison the body, and disrupt the functioning of organs. The patient's condition is deteriorating. Gangrene in the internal organs (lungs, intestines) proceeds according to the wet type.

• infectious - caused by pathogens;
• allergic - caused by severe inflammation as a result of an overreaction of the immune system;
• toxic - as a result of the action of toxic substances that enter the body from the outside or are formed in it itself in various diseases;
• as a result of impaired blood flow - usually caused by cardiovascular diseases, diabetes mellitus, etc.

Causes of gangrene

Circulatory disorders

Diseases of the cardiovascular system that can cause gangrene:

• severe pathologies of the heart, in which a pronounced violation of blood flow develops;
• atherosclerosis, leading to a significant partial or complete blockage of the lumen of the vessel;
• vessel thrombosis;
• thromboembolism - a condition when a piece of a blood clot breaks off, is transferred with the bloodstream to a smaller vessel and clogs it;
• obliterating endarteritis - a disease in which there is a narrowing of the lumen of the arteries of the legs, often develops in smokers;
• incorrectly applied plaster cast: if it is circular (deaf), then as a result of increasing edema, compression of blood vessels and impaired blood flow may occur;
• too long a tourniquet on the limb, which was applied to stop bleeding;
• prolonged squeezing by various debris, heavy objects during disasters.

Infection

Bacteria that cause infectious gangrene:

• coli;
• enterobacteria;
• Proteus;
• clostridia are bacteria that live in anoxic conditions and are the causative agents of gas gangrene.

Burns and frostbite

• temperature over +60⁰C - burns;
• temperature less than -15⁰C for a sufficiently long time - frostbite;
• electric shock - resembles a burn, because as a result of the passage of electricity, the tissues heat up, they literally burn;
• chemical burns with acids: lead to dry gangrene, since as a result of the action of acids, proteins coagulate and become insoluble in water;
• chemical burns with alkalis: lead to the appearance of gangrene, resembling wet (but this is not quite the same thing), since under the action of acids the tissues soften, a large amount of fluid accumulates in them.

• Destruction of tissues and circulatory disorders as a result of the direct action of high and low temperatures, acids, alkalis, electric current.
• development of inflammation. It is necessary so that the destroyed tissues can be absorbed. But the inflammatory process can be so strong that it itself has a damaging effect.
• Accession of an infection. When the tissues are destroyed and the body's defenses are weakened, the infection develops much more easily.

Mechanical injury

Symptoms of gangrene

Symptoms of wet gangrene

• Then the skin becomes cyanotic, dark blue, black with a green tint. Dark red spots appear.
• The affected limb swells, increases in size.
• Blisters filled with blood appear on the skin.
• There is no clear boundary between healthy and diseased tissue. Gradually, the zone of necrosis (necrosis) spreads (usually from the foot above), as the infection affects more and more new tissues.
• Fabrics that have a dirty gray color are exposed.
• There is an unpleasant putrid smell. It is caused by the formation of decay products of tissues and vital activity of bacteria.
• The general condition of the patient is disturbed: body temperature rises, headache, weakness, fatigue, chills, pallor and dry skin occur.
• The pulse becomes weak and frequent.

Symptoms of dry gangrene

• Initially, there is severe pain in the affected limb. It becomes pale, and then acquires a marbled bluish hue.
• Then the affected part of the limb decreases in size, acquires a black or dark brown color. The pain passes, in the area of ​​necrosis all sensitivity disappears.
• There is a clear boundary between the area of ​​necrosis and healthy tissues. New sites are not involved.
• The patient's condition remains normal, since with dry gangrene, toxins practically do not enter the bloodstream.
• Ultimately, the affected part of the limb dries up and mummifies. Occasionally, it can detach on its own - such an outcome is equated with self-healing.

Symptoms of certain types of gangrene

gas gangrene

If the wound is deep and narrow enough, then favorable conditions are created at its bottom: oxygen does not penetrate here, and clostridia can freely multiply.

Symptoms of gas gangrene:

• 6 hours after receiving the wound, the patient's condition worsens. There is weakness, fever, the pulse becomes weak and frequent.
• Swelling occurs in the area of ​​the wound. Its edges look lifeless.
• If muscles are visible in the wound, then they have such an appearance, as if boiled.
• The affected limb becomes edematous, acquires a gray-cyanotic color, blisters with blood appear on it.
• If you press on the skin in the area of ​​the wound, you can feel a specific crunch (as a result of the presence of gas bubbles in the tissues), and gas will begin to be released from the wound.
• An unpleasant sweetish-putrid smell emanates from the wound.
• The patient's condition is rapidly deteriorating - if help is not provided in time, then death will occur due to poisoning of the body with clostridia toxins and decaying tissues.

Fulminant gangrene of the scrotum (Fournier's gangrene)

Symptoms:

• There may be no symptoms for 2 to 7 days after the injury.
• Then there is constant severe pain in the genital area. You may notice swelling.
• Swelling and redness appear on the skin, the pain intensifies.
• The affected area of ​​the skin in the genital area becomes dark, gangrene develops. Pus starts to come out.

Gangrene of the lungs

Possible causes of gangrene of the lung:

• Infection, which can enter the lungs in different ways:
  • in case of inhalation of vomit, stomach contents;
  • with pneumonia and other diseases of the respiratory system;
  • with penetrating wounds of the chest;
  • drift from other foci of inflammation with blood and lymph flow.
• Pulmonary embolism- a condition in which a detached fragment of a blood clot enters the bloodstream, reaches the vessels of the lungs and clogs one of them. Part of the lung tissue ceases to receive the required amount of blood and dies. Infection joins.

• Increase in body temperature up to 39-40⁰C. Fever.
• Headache, insomnia.
• Poor appetite, weight loss.
• Pain in the affected side of the chest. It becomes stronger during a deep breath, frequent deep breathing.
• After a few days there is a persistent cough.
• There is a lot (up to 1 liter per day) of dirty-gray sputum with an unpleasant odor. She clears her throat "full".
• Shortness of breath, pale skin with a gray tint.
• In severe cases of the disease - a frequent weak pulse, lowering blood pressure, a decrease in the amount of urine.

Gangrene of the intestine

• bacterial infections;
• violation of blood flow in the vessels that feed the intestine, for example, with atherosclerosis;
• strangulated hernia - during the infringement, the vessels are compressed, and the blood flow is disturbed;
• inflammatory process - for example, gangrenous form of acute appendicitis.

• admixture of blood in the feces;
• bloating;
• increase in body temperature;
• violation of general well-being, weakness, lethargy, pallor.

Diagnosis of gangrene

Which doctor should I contact if there are signs of gangrene?

Specialists involved in the treatment of different types of gangrene:

• gangrene caused by a disease of the cardiovascular system and impaired blood flow - a vascular surgeon;
• infectious gangrene - surgeon (department of purulent surgery);
• gangrene as a result of burns, frostbite - traumatologist;
• gangrene of the lung - a thoracic surgeon (a surgeon who treats diseases of the chest organs);
• intestinal gangrene - abdominal (general) surgeon (a surgeon who treats diseases of the abdominal organs).

What happens in the doctor's office during an appointment?

• Where did it all start? What happened immediately before the onset of symptoms?
• Was there an injury? How did the wound heal?
• What diseases does the patient suffer from? The doctor is especially interested in diseases of the cardiovascular and nervous systems.
• Does the patient have diabetes?
• Was there hypothermia in the affected area?
• What symptoms are bothering you at the moment? When do they arise?
• What was your body temperature in recent days? What is the general health of the patient?

In a hospital, a doctor can perform a simple test: a thread is tied around the affected limb. If edema increases during gangrene, then after a while the thread becomes “tight” and digs into the skin.

Usually, after examining the patient in the office, revealing signs of gangrene, the doctor sends him to the hospital. There, an examination is carried out and the most appropriate treatment tactics are selected.

Examination for gangrene

Study title	Description	How is it carried out?
General blood analysis	General clinical routine study, which is prescribed for almost all patients with any disease. With gangrene, inflammatory changes are detected in the general blood test: an increase in the number of leukocytes.	Blood for research is taken in the standard way from a finger or from a vein (usually, if they plan to do a biochemical blood test at the same time). If the result of the study is needed urgently, then in the clinic it can be ready in a few minutes.
Blood chemistry	It helps to clarify some of the nuances, in particular, concerning the cause of gangrene: in diabetes - an increase in glucose levels; with atherosclerosis - an increase in cholesterol levels.	Blood for analysis is taken from a vein, on an empty stomach.
Blood test for sterility	An analysis that helps detect blood poisoning (sepsis) in infectious gangrene. You can establish the pathogen, its sensitivity to different types of antibacterial drugs.	Blood for research is taken from a vein, and then placed on a special nutrient medium. If growth of colonies is noted, then they are studied under a microscope, their sensitivity to antibacterial drugs is checked.
Bacteriological examination of the contents and discharge from the wound.	The analysis allows to identify the causative agent of infectious gangrene and its sensitivity to antibacterial drugs.	Smears are taken, separated from the wound and sown on a nutrient medium. Then the grown colonies of microorganisms are studied under a microscope, their sensitivity to antibacterial drugs is determined.
X-ray of the muscles in the affected area	X-ray examination helps to confirm gas gangrene. In the pictures, the muscles look porous.	Do conventional x-rays in different projections.
Examination for gangrene of the lung
Chest x-ray	Gangrene of the lung looks like an area of ​​blackout on x-rays.	X-rays of the chest are taken in two projections: direct and lateral.
Computed tomography of the chest	CT is a more accurate technique than X-ray. On the pictures, you can get layered sections or a three-dimensional image of the lung, in which the area of ​​necrosis is clearly visible.	Computed tomography for gangrene of the lung is carried out according to the standard method using a computed tomograph.
Chest ultrasound	During an ultrasound examination of the chest, a focus of necrosis in the lungs, an accumulation of inflammatory fluid between the lung and the chest wall, can be detected.	The doctor lays the patient on the couch, lubricates the skin with a special gel and conducts an examination using an ultrasonic sensor.
Bronchoscopy	A study during which a bronchoscope is inserted into the trachea and large bronchi - a special flexible endoscopic instrument with a miniature video camera. The doctor examines the lumen of the bronchi from the inside, and at the same time can reveal: inflammation; overlapping of the lumen of the bronchus with an area of ​​necrosis.	During the examination, the doctor inserts a special flexible instrument, the bronchoscope, into the patient's airways. In adult patients, bronchoscopy can be performed under local anesthesia. In children - only under general anesthesia.
Microscopic examination of sputum	With gangrene of the lung in the sputum are found: leukocytes(white blood cells); erythrocytes(red blood cells); fragments of dead lung tissue.	The sputum that the patient coughs up is collected and examined under a microscope.
Bacteriological examination of sputum	An analysis that allows you to identify pathogens, determine their sensitivity to antibacterial drugs.	The sputum of the patient is brought to a special nutrient medium, then colonies of bacteria grown on it are studied.
Examination for gangrene of the intestine
X-ray of the abdomen	On x-rays (done without contrast), the doctor can detect signs of intestinal destruction, peritonitis. This is an indication for emergency surgery.	Make conventional x-rays without contrast in direct projection (front).
Laparoscopy	Laparoscopy is an endoscopic examination, during which the doctor can examine the abdominal cavity from the inside, identify the affected areas of the intestine. Conducted according to indications.	Under anesthesia, punctures are made in the wall of the patient's abdomen, through which endoscopic equipment is inserted: a miniature video camera and special instruments. Laparoscopy is equivalent to surgery and is performed in the operating room, under sterile conditions.

Treatment of gangrene

Treatment depending on the type of gangrene:

Prognosis for gangrene

With wet gangrene, there is a threat to the life of the patient. The death of the patient can occur as a result of complications from the heart, liver, kidneys.

With gangrene of the lung, from 20% to 40% of patients currently die. Causes:

• development of sepsis (blood poisoning);
• dysfunction of all organs due to the action of toxins released from the focus of necrosis;
• pulmonary hemorrhage.

Prevention of gangrene

• timely and correct treatment of diseases of the heart and blood vessels, accompanied by impaired blood flow;
• timely treatment of wounds (prevention of gas gangrene);
• timely examination by a doctor, treatment of burns and frostbite;
• fight against bad habits, timely treatment of infections of the respiratory system (prevention of lung gangrene).