Gangrene is a type of tissue death caused by lack of blood supply and can be caused by blocked arteries or infection. There are several types of gangrene including dry gangrene caused by gradual arterial blockage, wet gangrene caused by sudden blockage and infection, and gas gangrene caused by Clostridium bacteria infection. Clinical features include discolored, numb skin that is dry in dry gangrene and swollen in wet gangrene, with a foul smell and crepitus in gas gangrene. Treatment depends on the type but may include antibiotics, surgery to remove dead tissue, and amputation in severe cases.

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 !!!!!