#general surgery # kavya bhola

1. GANGRENE
Type of tissue death caused by not
enough blood supply.

2. ETIOLOGY
NECROSIS OF TISSUE
WITH
PUTREFACTION.
• Obstruction of
blood
• Necrosis
• Superimposed
bacterial infection
CVS CAUSES
• Atherosclerosis
• Embolic gangrene
• Diabetic
Gangrene
• Cervical rib
gangrene
• Burger’s disease
• Raynaud’s disease
• Deep vein
thrombosis
TRAUMA
• Direct injury to
main artery
• Indirect Crushing
Injury

3. ETIOLOGY
INFECTIVE
GANGRENE
• Carbuncule
• Cancrum oris
• Gas Gangrene
(closteridium
inf)
• Post operative
• Atherosclerosis
DIABETIC
GANGRENE
• Atherosclerosis
• Neuropathy
• ↑Blood sugar
predisposes to
infection
PHYSICAL
CAUSES
• Extreme heat /
burn.
• Extreme cold.
• Acids & Alkalies
• X-ray radiation.

4. CLINICAL FEATURES
Absence of aertial
pulsations
Loss of temperature,
Sensation &hair
Colour changes
Blue,purple,brown,&
black.
Foul smelling discharge
Smelling & crepitus in
case of gas gangrene.
Loss of function

5. CLINICAL TYPES OF
GANGRENE
DRY
GANGRENE
WET
GANGRENE
GAS
GANGRENE

6. DRY GANGRENE

7. ETIOLOGY
 When there is gradual obstruction in the arterial lumen
 When the artery is occluded but the venous return is
intact
 When the gangrenous area is exposed to evaporation eg.
Toes
 When there is no infection
 When the gangrenous area was not primarily
oedematous

8. CLINICAL FEATURES
• Gradual Arterial obstruction
• Senile
• Affected part
 Dry
 Wrinkled
 Shrunken
 Mumified
 Discoloured
 Line of Demarcation

9. TREATMENT
• Ampulation
• Revascularation - atherosclerosed part of
artery

10. WET GANGRENE

11. ETIOLOGY
 Sudden arterial or venous obstruction -
 Embolism
 Crush injury

12. CLINICAL FEATURES
• AFFECTED PART IS -:
• Swollen & discoloured
• Infection & Putrefaction
• Toxaemia & High grade
fever
• Line of demarcation
absent.

13. TREATMENT
LIMB SAVING
 Heavy Antibiotic.
 Revascularisation.
LIFE SAVING
 Sacrifice the limb due to toxaemia.

14. GAS GANGRENE

15. ETIOLOGY
CAUSATIVE ORGANISM
1. Clostridium - welchi (60%)
2. Clostri dium - odematiens
3. Clostridium - septicum
4. Clostridium - histolyticus
SOURCE – Mainly Soil
PATHOGENESIS
•Clostridium organism cause infective gangrene by involving
mainly skeletal muscle.
•Low blood supply and low oxygen perfussion

16. THE ORGANISM MULTIPLY TO
RELEASE TOXINS
NASELECITHI
Haemolytic ,
membranolytic
and necrotic –
myositis.
HAEMOLYSIN
Extensive
haemolysis
HYALURONIDASE
Rapid spread of
gas
PROTEINASE
Breaking protiens
These will cause inflamation ,oedema ,necrosis & gangrene of
muscles.

17. 17

18. CLINICAL FEATURES
• Necrosis→septicaemia and P.C.F
• Crepitus felt due to gases
• Temperature – LOW GRADE
• Wound under tension–foul smelling
discharge
• Khaki brown coloured skin due to
haemolysis.

19. CLINICAL TYPES
FULMINANT
TYPE
• Rapid progress
• Toxemia
• Renal or liver
failure
MASSIVE TYPE
• Whole of one
limb involved
GROUP TYPE
• Extensors of
thigh
• Flexors of leg
SINGLE MUSCLE
TYPE
• One single
muscle
SUBCUTANEOUS
TYPE
• Superficial

20. PROPHYLAXIS
• Proper wound cleaning
• Antibiotics i / v
• Minimum use of tourniquet
• Gentle & effective p.O.P
• Anti gas gangrene serum.

21. TREATMENT
• Excision of necrotic tissue & muscle
• Proper antibiotic
• Blood transfusion.
• Hyperbaric oxygen.

22. MELENEY’S GANGRENE
 Post –operative streptococcal or staphylococcal infection
 Involves skin of abdomen →Inflammed app. & Gb op
TREATMENT – ANTIBIOTIC THERAPY

23. CANCRUM ORIS / NOVA
Infective gangrene of jaw, cheeks and lips

24. ETIOLOGY
• Fusiform bacillia
• Spirochete
(borelliavincentia)
PREDISPOSING FACTORS
• Malnourished children
• Famines
• Complication of
measles,kalazar
• Poor oral hyegine
• Enteric fever.

25. CLINICAL FEATURES
• Tooth infection
• Spreads to maxilla,mandible& then
soft tissue of the cheek.
• Oral mucosa ulcerated
• Tissue & bone is gangrenous
• Foul smell & purulent discharge
from mouth.
• Hole in the cheek.
• Unable to open mouth properly.
• Signs & symptoms of toxaemia.

26. TREATMENT
• Antibiotic systemic
• Multivitamins
• Repeated antibiotic mouth wash
• Sequestomy in chronic Osteomyelitis of mandible
• Plastic surgery of lip & soft tissue

27. INVESTIGATIONS

28. INVESTIGATIONS
(TOWARDS DETERMINING THE CAUSE)
 Blood sugar (diabetes)
 Serum cholesterol (atherosclerosis)
 Vdrl and kahn (syphilis)
 URINE FOR SUGAR , ACETONE BODIES, etc.
 X – ray for the following -:
 calcification of arteries (atherosclerosis)
 Gas bubbles (gas gangrene)
 Cervical rib

29. INVESTIGATIONS
(TOWARDS THE LEVEL OF GANGRENE)
 Level of arterial; pulsation.
 Temprature gradient by palpation or
thermocouple.
 Doppler ultrasound blood flow detector.
 Oscillometry to detect pulsation at different levels.
 Arteriography. It may help in selecting the site of
amputation.

30. THANK YOU !!!!!