Gangrene is the death of body tissue due to loss of blood supply. It is caused by infection or reduced blood flow and can be dry, wet, or gas gangrene. Dry gangrene develops slowly in tissues like the feet of diabetics. Wet gangrene occurs rapidly in moist tissues and causes swelling and odor. Gas gangrene is a medical emergency caused by soil bacteria that produce tissue-damaging gases. Treatment involves antibiotics, surgery to remove dead tissue, and sometimes amputation.

2. Dr. Mohamed A. El Rouby
Assistant Professor of Plastic Surgery

3. Gangrene
 The word "gangrene" comes from the
Greek "ganggraina" denoting "an
eating sore that ends in mortification".

4. MEDICAL DEFFINITION:
Gangrene: The death of body tissue
due to the loss of blood supply to that
tissue, sometimes permitting bacteria
to invade it and accelerate its decay.

5. NNNNNNNNN Gangrene is a complication of
necrosis “ N cell death N ”
characterized by the decay of body
tissues, which become black and
appearing “rotten”.
 It is caused by infection or ischemia,
such as a thrombosis.

6. TYPES OF GANGRENE
 DRY GANGRENE
 WET GANGRENE
 GAS GANGRENE

7. DRY GANGRENE
 Dry gangrene usually develops Slowly
due to blockage of arterial blood flow.
 People with impaired peripheral blood
flow, such as diabetics, arteriosclerosis
are at greater risk of contracting dry
gangrene.
 The affected part is dry, shrunken and
dark black, resembling mummified flesh.

8. DRY GANGRENE

9. DRY GANGRENE

10. DRY GANGRENE

11. WET GANGERNE
 Wet gangrene usually develops rapidly
due to blockage of venous and/or arterial
blood flow.
 In wet gangrene, the tissue is infected by
microorganisms, which cause tissue to
swell and emit a fawol order.
 The affected part is saturated with
stagnant blood which promotes the rapid
growth of bacteria.

12. WET GANGRENE
 Wet gangrene occurs in naturally
moist tissue and organs such as the
mouth, bowel, lungs, cervix, and
vulva.
 Bedsores occurring on body parts
such as the sacrum, buttocks and
heels (not in “moist” areas) are also
categorized as wet gangrene
infections.

13. WET GANGRENE
 The toxic products formed by bacteria
are absorbed causing systemic
manifestation of bacteria and finally
death.
 The affected part is soft, putrid, rotten
and dark.

14. WET GANGREEN

15. WET GANGRENE

16. WET GANGRENE

17. GAS GANGRENE
 Gas gangrene is an anaerobic bacterial
infection that produces gas within deep
tissues.
 Infection spreads rapidly as the gases
produced by bacteria expand and effect
healthy tissue.
 Gas gangrene is caused by a
environmental bacteria. (mostly found in
soil).

18. GAS GANGRENE
 Gas gangrene can cause necrosis,
gas production, and sepsis.
 Progression to toxemia and shock is
often very rapid.
 Because of its ability to quickly spread
to surrounding tissues, gas gangrene
should be treated as a medical
emergency.

19. GAS GANENE

20. GAS GANGRENE

21. GAS GANGRENE

22. GAS GANGRENE

23. SPECIFIC GANGRENES
 Necrotizing fasciitis affects the
deeper layers of the skin and Fascia.
 Noma is a gangrene of the face.
 Fournier gangrene usually affects the
male genitals.

24. NECROTIZING FASCIITIS
 Commonly known as flesh-eating
disease or flesh-eating bacteria.
 Rare infection of the deeper layers of
skin and easily spread within the
subcutaneous tissue

25. NECROTIZING FASCIITIS

26. NECROTIZING FASCIITIS

27. NECROTIZING FASCIITIS

28. What is Necrotizing Fasciitis?
 Other names:
◦ β-hemolytic streptococcal gangrene
◦ Meleney ulcer
◦ acute dermal gangrene
◦ hospital gangrene
◦ necrotizing cellulitis.
 3 types of NF (causative organism):
◦ Type I : a polymicrobial flora.
◦ Type II Group A β-Streptococcus bacteria
(most common case)
◦ Type III : marine vibrio gram-negative rods.

29. How does one contract NF?
 exposed to an individual with an opening in
their skin.
◦ direct contact with someone carrying the
bacteria
◦ the bacterium being carried by the person itself.
 The entrance can be as minor as a paper
cut or a pin prick.
 Can happen to anyone!!!!!!?

30. Cofactors that Increase risks
 Immuno-suppression
 Severe illnesses: heart, lung, or liver
disease, Burns
 Diabetes
 Obesity
 Alcoholism

31. Pathogenesis:
 Bacterial infection and release of exotoxins
 Inflammatory response by immune system
 Cytokines inhibit function of phagocytic cells
◦ Anaerobes thrive speeding up necrotic process
 Endothelial cells will be damaged;
 Poor blood supply inhibit:
◦ Inflammatory response process
◦ Ability to transfer antibiotics to the affected fascial
layer
 Vasoconstriction and thrombosis  edema  hypoxia 
necrosis of the fascia, skin, soft tissue, and muscles
involving the subcutaneous nerves.

32. Clinical Picture: early symptoms and
signs of NF?
 Clinically indistinguishable
from other possible soft tissue
infections.
 General: Flu like symptoms
that include fever, chills,
nausea, weakness, dizziness,
aches and a heat rate of more
than 100 beats per minute.
 Local: Skin becomes tender,
warm, red in color, and will
start to swell.

33. Advanced symptoms…
 Swelling and multiple
discolored patches
develop to produce a
large area of gangrenous
skin.
 Initial necrosis appears as
a massive destruction of
the skin and
subcutaneous layer.
 Large, dark marks that
become blisters filled with
a yellow-green necrotic
fluid appear.

34. Critical symptoms…
 30% of patient’s develop
hemorrhagic bullae
thrombosis  necrotic
eschars.
 Unconsciousness,
septic shock while
contracting a high fever,
high white blood count.
 This may result into
respiratory failure, heart
failure and renal failure.

35. Investigations
 Some of these tests include:
1. CBC
2. creatinine, glucose, albumin, and
calcium levels (inflammatory response
syndrome)
3. X-ray
4. CT, and MRI scanning
5. The most importantly culture and
sensitivity tests and tissue biopsy.

36. NOMA
 Is a gangrenous
disease leading to
tissue destruction of
the face, especially
the mouth and cheek.
 Risk factors include
severe protein mal
nutrition and
unsanitary conditions.

37. NOMA

38. FOURNIER GANGRENE
 A type of necrotizing infection usually
affecting the male genitals.
 In the majority of cases it is a mixed
infection caused by both aerobic and
anaerobic bacteria

39. FOURNIER GANGRENE

40. FOURNIER GANGRENE

41. FOURNIER GANGRENE

42. Management:
 Medical Emergency:
◦ Clinical Diagnosis
◦ Investigations.
◦ Treatment: The best treatment for
gangrene is revascularization!!!?
 The method of treatment is generally
determined depending on location of
affected tissue and extent of tissue
loss.

43. Management:
 Medical treatment.
 Surgical Debridement .. Amputation.
◦ Coverage of the defect.
 Others:
◦ Maggot therapy.
◦ Hyperbaric oxygen therapy