On the basis of Physiotherapy and Medicine

1. Gangrene +
Peripheral
Vascular
Diseases
By: Shreya Gupta [BPT 3rd yr]

2. Gangrene
Gangrene is a type of tissue death due to lack
of blood supply to a specific body segments.
The lack of blood supply can be either due to
lack of blood flow or serious bacterial infection.
It is associated with people suffering
from diabetes, Arthrosclerosis and long-term
tobacco smoking.

3. Gangrene commonly affects the extremities,
including your toes, fingers and limbs, but it can
also occur in your muscles and internal organs.
Mainly involved regions are the feet and hands.
It can be classified as dry gangrene, wet
gangrene, gas gangrene, internal gangrene, and
necrotizing fasciitis.
It is a form of necrosis of tissue with superadded
putrefaction. It may be caused either by
inflammatory or ischemic.

4. Signs + Symptoms
Skin discoloration — ranging from pale to blue, purple, black,
bronze or red, depending on the type of gangrene you have
Swelling or the formation of blisters filled with fluid on the skin
A clear line between healthy and damaged skin
Sudden, severe pain followed by a feeling of numbness
A foul-smelling discharge leaking from a sore
Thin, shiny skin, or skin without hair
Skin that feels cool or cold to the touch

5. Some other symptoms involve numbness, pain,
skin breakdown and coolness of the body region
suffering from gangrene.
Gangrene is a serious condition and needs
immediate treatment.
– Persistent fever
– Skin changes — including discoloration, warmth,
swelling, blisters or lesions — that won't go away
– A foul-smelling discharge leaking from a sore
– Sudden pain at the site of a recent surgery or trauma
– Skin that's pale, hard, cold and numb

6. Causes
Lack of blood supply
Infection
Trauma

7. Types
Dry gangrene is a form of coagulative necrosis that develops
in ischemic tissue, where the blood supply is inadequate to keep
tissue viable. Dry gangrene is often due to peripheral artery
disease, but can be due to acute limb ischemia.
Wet, or infected, gangrene is characterized by thriving bacteria
and has a poor prognosis (compared to dry gangrene) due to
sepsis resulting from the free communication between infected
fluid and circulatory fluid. The affected part is edematous, soft,
putrid, rotten, and dark.

8. Gas gangrene is a bacterial infection that produces gas within
tissues. Infection spreads rapidly as the gases produced by the
bacteria expand and infiltrate healthy tissue in the vicinity. Gas
gangrene can cause necrosis, gas production, and sepsis.
Necrotizing fasciitis is an infection that spreads deep into the
body along tissue planes.
Fournier gangrene is a type of necrotizing fasciitis that usually
affects the genitals and groin.
Venous limb gangrene may be caused by heparin-induced
thrombocytopenia and thrombosis.
Severe mesenteric ischemia may result in gangrene of the small
intestine.
Severe ischemic colitis may result in gangrene of the large
intestine.

9. Dry
Gangrene

10. Wet
Gangrene

11. Risk Factors
Diabetes
Blood vessel disease
Severe injury/ Infection
Obesity
Smoking
Immunosuppression
Drugs

12. Treatment
Lifestyle management
Medications [ It can include antiplatelet drug, anticoagulant,
and fibrinolytics.]
Surgery
Hyperbaric oxygen therapy treatment is used to treat gas
gangrene. It increases pressure and oxygen content to allow
blood to carry more oxygen to inhibit anaerobic organism
growth and reproduction.

13. Peripheral Vascular
DiseasesPeripheral artery disease (PAD) is an abnormal narrowing
of arteries other than those that supply the heart or brain.
 When narrowing occurs in the heart, it is called coronary artery
disease, and in the brain, it is called cerebrovascular disease.
PVD typically causes pain and fatigue, often in your legs, and
especially during exercise.
In PVD, blood vessels become narrowed and blood flow decreases.
This can be due to arteriosclerosis or it can be caused by blood
vessel spasms.

17. Symptoms
Skin ulcers
Bluish Skin
Cold Skin
Abnormal nails and hair growth of the affected leg

18. Causes
Emotional stress
Cold temperatures
Operating vibrating machinery or tools
Drugs
Smoking
High blood pressure
Diabetes
High cholesterol

19. Risk Factors
are over age 50
are overweight
have abnormal cholesterol
have a history of cerebrovascular disease or stroke
have heart disease
have diabetes
have a family history of high cholesterol, high blood pressure, or PVD
have high blood pressure
have kidney disease on hemodialysis

20. Diagnosis
Angiography
CT Scan
MRA

21. Treatment
Management of the disease leading to the PVD; like
diabetes, hypertension, increased cholesterol levels in
blood.
Drugs such as antiplatelets can be used for the
treatment; like wise statins can be used to control the
clot formation and also control the cholesterol levels in
the body.

22. Complications
tissue death, which can lead to limb amputation
impotence
pale skin
pain at rest and with movement
severe pain that restricts mobility
wounds that don’t heal
life-threatening infections of the bones and blood stream