gangrene

1. GANGRENE

2. GANGRENE
• Macroscopic death of tissue with super
added putrefaction .
• Types: dry and wet

4. DRY GANGRENE
• Blood supply: arterial – gradually deprived
venous flow – unimpeded
• Colour change: Greenish- black – dry-
mummfied.
• Line of demarcation is present.

5. • Line of demarcation:
• Dead tissue and living tissue.
• Band of Hyperemia
• layer of granulation
• Hyperesthesia
• seen in:
Senile, diabetic, buerger’s ,raynaud’s, frost
bite, vascular occlusion, embolism, ligation

6. WET GANGRENE
• Arterial & venousblock
• Infection and putrefaction.
• Cold ,pulseless, swollen, oedematous, blebs
• Horrible odour
• No line of demarcation
• Constitutional symptoms present.
• Spreads faster
• Seen in :acute inflammation, venous thrombosis,
Gas gangrene, bed sores

7. DRYGANGRENE WETGANGRENE

8. CAUSES
• ARTERIAL OCCLUSION: atherosclerosis, embolism,
raynaud’s, buerger’s, cervical rib,syphilitic
• VENOUS OBSTRUCTION: DVT
• NERVOUS DISEASE:peripheral neuritis,
tabes dorsalis, syringomyelia, leprosy, hemiplegia
• TRAUMATIC :Direct or indirect
• INFECTIVE: carbuncle, cancrum oris, gas gangrene,
fourniers gangrene

9. Raynauds disease:young women, pulse
unaffected.
Embolic Gangrene: sudden, pain, cold andnumb
limb, pulse less

10.  Fournier’sgangrene:
• vascular ,infective gangrene of scrotum
• Obliterative arteritis of scrotum –
cutaneous
gangrene
 Gangrene of internal
organs: bowel, gall
bladder, appendix etc.
• Wet type of gangrene
• Incarcerated hernia or volvulus
• sepsis

11. GAS GANGRENE
•Clostridium
•Traumaand ischaemia
•Exotoxinsproduced
•Necrosis withgasproduction – rapidly
•CF:pain ,fever, swelling, Toxaemia,
foul sm khakibrown skin, Crepitus
• Types:fulminant,massive,group ,
subcutaneous, single

12. • TREATMENT:
• INJ benzyl pencillin 20 lac IU 4hrly + metrinidazole
• Fresh blood transfusion
• Polyvalent antiserum 25000 units iv every 6hrs
• Hyperbaric oxygen
• Excision and debridement
• Rehydration and electrolyte management
• amputation8

13. PHYSICAL GANGRENE
Frost bite: exposure to cold
• Damage to arteries-edema- blisters – gangrene
• Painless, waxy.
• Dry gangrene

14. BURNS GANGRENE:
ELECTRICAL GANGRENE:
CORROSIVE GANGRENE:

15. Drugs causing gangrene:
• Inadvertent injection of drugs
• Iatrogenic- intraarterial injection of
thiopentane
• Ergot preparations

16. INVESTIGATION
1. Blood: routineexamination
WR – Syphilis
sugar- diabetes, TG,cholesterol.
urea, electrolytes
2. Urine: sugar ,renovascular insufficiency
3. X ray:atherosclerosis , aneursym,
gas –gas gangrene, bone erosion ingangrene
4. ECG- Cardiac status
5. USG – ABDOMEN
6.Pus - culture

17. XRAY
GAS GANGRENE ATHEROSCLEROSIS

18. 7.Doppler:
 Duplex8scan:b mode usg & doppler
Arterial flow , flow rate, velocity, stenosis, block.
 Ankle brachial pressure index: <0.3 severe ischemia – gangrene
8. SEGMENTAL PRESSURE:
9. PLETHYSMOGRAPHY:
• Segmental plethysmography is introduced by placing venous occlusioncuffs
around thigh, calf,ankle
• Cuffs inflated to 65mmhg and pulsation is quantitative measure ofarterial
diseases.

20. 10. Arteriography:
• Contrast – Hyphaque 45( sodium diatriozoate)
• aortoiliac / femoropopliteal arteriography.
 Retrograde percutaneous catherterization:
• Seldinger’s technique
• Xraystaken
• TAO – CORKSCREW
• May ppt gangrene

21. SELDINGER
S
TECHNIQUE

22. 12. CT/ MRI Angiogram:
13.OSCILLOMETRY: we can assesslevel amputation
• Gasgangrene: culture, x ray, LFT, CT,
Sr urea, creatinine

23. 8
ELECTROMAGNETIC FLOW METER

24. ISOTOPETECNIQUE
• Xenon133 IM
• Technetium 99
• Recent IV injection of isotope has been used to get
direct arterial visualisation
• Gamma camera used to picturise blood flow

25. BROWNSVASO MOTOR
INDEX:
Method : nerve block with local
anesthesia or spinal anesthesia is
given and any rise in skin temperature
is recorded and compared with rise of
mouth temperature
Browns vasomotor index > 3.5 or more
operation is advisable

26. TREATMENT
LIMB SAVING METHODS:
• DRUGS:
Antibiotics
Vasodilators
Pentoxiphylline, dipyridamole, aspirin, toclpidine.

27. Care of foot:
• Dry
• Foot wear- MCR
• Nutrition
• Avoid injury, pressure, warming
• Pus drainage
• Control diabetes
• Treat cause

28. Surgeries:
• Lumbar sympathectomy
• omentoplasty
• Profundaplasty
• Endarterioectomy
• Femoropopliteal thrombectomy
• Arterial bypass graft

29. SYMPATHECTOMY
PROFUNDOPLASTY

30. BYPASSEMBOLECTOMY
GRAFT

31. ENDARTECTOMY
OMENTOPLASTY

32. •Life saving
procedure:
• AMPUTATION:
• Ray amputation
• Below knee amputation
• Above knee amputation:
• Trans condylar –Gritti stokes amputation:
• Modified syme’s:

33. RAYAMPUTATION

34. ABOVEKNEE
AMPUTATION

35. GULLITONAMPUTATION

36. • Lisfranc’s amputation:
• Choparts amputation:
• Transmetatarsal amputation