Gangrene
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Complete understanding about definition, causes, forms of gangrene and management with special emphasis on Gas gangrene
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Gangrene
- 2. What is Gangrene? Macroscopic death of tissue with superadded putrefaction.. 02
- 3. 03 TAO Atherosclerotic Gangrene Acute Embolic Gangrene Raynaud's Disease Cervical Rib Vasculitis Syndrome Polycythemia Hemiplegia Paraplegia Bed Sore Tabes Dorsalis Leprosy Causes Cardiovascular Causes Neurological Causes Traumatic Causes Direct Indirect Physical Causes Sunrays Radiation Frost Bite Corrosive acids Drugs Ergotamine Diabetic Gangrene Acute infective Gangrene Boil Carbuncle Cancrum oris Gas Gangrene
- 4. 04 Pre-gangrene symptoms PALLOR ON ELEVATION CONGESTION ON DEPENDENT POSITION GUTTERING OF VEINS POOR CAPILLARY FILLING THICKENING OR SCALING OF SKIN REST PAIN
- 5. Clinical Features 05 Loss of Pulsation Loss of Temperature Loss of Function Loss of Colour Loss of Sensation SIGNS
- 6. 06 DRY GANGRENE WET GANGRENE Forms of Gangrene
- 7. 07 Begins in distal part of limbs due to ischaemia. Line of separation is present Diseases: Arteriosclerosis, Buerger's disease, Raynaud's disease, Ergot Poisoning, Trauma Typical Example :- Toes and feet of an old patient due to arteriosclerosis. Dry Gangrene Dry Gangrene is characterised by dry and shriveled skin ranging in colour from brown to puplish blue or black. It occurs most commonly in people who have arterial blood vessel disease.
- 8. 08 Site- Mouth, bowel, lung, cervix, vulva etc. Venous or Arterial obstruction Septicaemia. Foul smelling Spreads faster Typical Example:- Gangrene of Bowel, commonly due to strangulated hernia. Example :- Diabetic Foot, Bed Sores Wet Gangrene Gangrene is referred to as "wet" when it occurs in naturally moist tissues and organs & there's a bacterial infection in the affected tissue. Affected part is soft, swollen, putrid ,rotten & dark.
- 9. Dry v/s Wet Gangrene Commonly limbs Arterial Occlusion Dry, shrivelled & mummified Fail to survive Usually present Absent Absent Limited due to very little blood supply Generally Better due to little septicaemia DRY GANGRENE 09 Common in bowel. Venous Obstruction mainly Wet, turgid, swollen, oedematous Numerous present Absent Foul odour May be present Marked due to stuffing of organ with blood Generally Poor due to profound Septicaemia WET GANGRENE Site Mechanisms Local findings Bacteria Line of demarcation Odour Crepitus Putrefaction Prognosis FEATURE
- 10. Treatment 10 Treatment depends on the type or form of Gangrene... Generally treatment involves:- Correct hypotension Control infection Treat dehydration Early debridement Administer hyperbaric oxygen Give blood transfusion Passive immunisation To save life, amputate.
- 11. 11 Aetiology :- Clostridium perfringens (60%) Other organisms are Clostridium septicum, Clostridium oedematiens, Clostridium histolyticum. Source of infection :- Foriegn Body such as manured soil or cultivated soil, bullets, glass pieces, normal intestines. Gas Gangrene Gas Gangrene is a special form of wet gangrene caused by gas forming clostridia (gram positive anaerobic Bacteria) which is a highly fatal, rapidly spreading infection that results in myonecrosis.
- 13. 13 Gas Gangrene Clinical Features :- Severe pain and gross oedema of the wound Thin brownish fluid escapes which has sickly sweet odour Palpable crepitus Colour changes in the muscles Skin becomes khaki-coloured due to haemolysis Dermonecrosis Haemolysis Profound toxaemia Necrosis of the tissues Breakdown of collagen fibres Local Features- 1. 2. 3. 4. 5. General Features 1. 2. 3. 4. 5.
- 14. 14 Gas Gangrene Diagnosis :- Examine the pus under microscope after staining with Giemsa stain Prophylaxis :- DEBRIDEMENT - All dead, necrotic tissue, bone pieces and foreign material are removed. Pus is evacuated. Wound is thoroughly irrigated with antiseptic agents. PROPHYLACTIC ANTIBIOTICS - Penicillin is the drug of choice. Injection crystalline penicillin 10-20 lakh units, 4-6th hourly is given for a period of seven days. 1. 2.
- 15. 15 Gas Gangrene Treatment of established Gas Gangrene:- Emergency surgery which includes excision of all dead muscles and necrotic tissues by using generous, long incisions-debridement. Penicillin to be continued. Blood transfusions before, during and after surgery. Polyvalent anti-gas gangrene serum. Hyperbaric oxygen will reduce the amount of toxin produced by the organisms (controversial). Do not hesitate to amputate if it saves the life, because this is the only measure in late cases. 1. 2. 3. 4. 5. 6.
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