- Gangrene reasons
- Gangrene symptoms
- Treatment of gangrene
Gangrene – a disease at which there is a necrosis (necrosis) of body parts or bodies accompanied with characteristic change of coloring of the died-off fabrics from bluish to black.
The disease can affect skin, hypodermic cellulose, muscles, a gall bladder, lungs, extremities, intestines. Gangrene begins to develop in case of the termination of receipt to body tissues of oxygen and, as a rule, meets in the places, most remote from heart (for example, in fingers of hands or legs) or in places local disturbance of blood circulation (for example, in lungs against the background of a heart attack).
The reasons of gangrene are various and conditionally are divided into three groups. First, the disease arises at the states leading to disturbance of blood supply of fabrics: at defeat of blood vessels owing to obstruction of arterial trunks, vasoconstriction at spasms, anatomic changes. The atherosclerosis of vessels which is often the reason of heart attacks and thromboses, defeat of vessels at a diabetes mellitus and a Thrombangiitis obliterans (an inflammation of arteries and veins) – all this can become a push to a gangrenosis. Secondly, gangrene can develop under the influence of physical (frostbites of fabrics, burns of the III degree), mechanical (injuries with crush of fabrics and disturbance of integrity of vessels, decubituses) and chemical factors (burns acids, alkalis, etc.). Besides, gangrene can develop against the background of infections (anaerobic bacteria, colibacilli, streptococci, etc.), most often at deep gunshot or knife wounds, and at patients with a diabetes mellitus – even at insignificant grazes.
Distinguish dry and wet gangrene (depending on a consistence of the died-off fabric), and also depending on an etiology – infectious, toxic, allergic and depending on a pathogeny - fulminant, gas and hospital. Most often presently meets dry, wet and gas gangrenes.
Dry gangrene most often affects extremities at the exhausted patients. Disturbance of blood circulation and obstruction of blood vessels begins, and this process goes slowly, for several months, and sometimes and years. There is severe pain in fingers, ступнях, the extremity turns pale, takes a marble form, becomes cold, the feeling of numbness appears. Later affected areas begin to lose sensitivity. Slowly the necrosis of fabrics develops: they dry, shrivel, decrease in volumes, become dense and get dark, bluish-black coloring. The border between healthy and dead fabric is visually accurately traced, the putrefactive smell is absent. The general condition of the patient normal, organism intoxication practically does not occur as devitalized fabrics do not rot. Dry gangrene if does not pass into a wet form, does not pose a threat to health of the patient. It, as a rule, does not progress, and is limited only to a part of a segment of an extremity. As processes of dying off at dry gangrene proceed slowly, the organism manages to turn on protective mechanisms and to begin physiological isolation of the dying fabric from live, healthy.
Wet gangrene, putrefactive, develops promptly because of bystry obstruction of vessels of the struck body. This form of a disease results from injuries, heavy burns, frostbites. Devitalized fabrics do not manage to dry up, begin to decay and serve as the good environment for food and reproduction of microbes which begin to develop quickly and by that even more provoke growth of the area of gangrene. Decomposition products of fabrics are soaked up in an organism and lead to severe intoxication of the patient. Wet gangrene affects lungs, intestines, a gall bladder, and also extremities. The body increases in volume, gains bluish-violet color, the putrefactive smell is felt. The clinical picture of damage of extremities begins with blanching of skin and emergence on it bluish veins, dark stains, peeling of epidermis. Gradually fabrics turn into fetid wet dark weight. The condition of the patient very heavy, is observed high temperature, dry language, organism dehydration, slackness, low arterial pressure, a condition of the general intoxication by waste products of bacteria. Process of a necrosis of fabrics progresses, extends to healthy sites and creates threat for life of the patient who can die from sepsis. Especially dangerously and hard wet gangrene at patients with a diabetes mellitus who have low body resistance proceeds.
Gas gangrene develops at large crushes of fabrics at hit of anaerobic microbes (bullet and avulsive wounds, the fragmentary hurt wounds especially contaminated by the earth covered with pieces of dirty clothes). Causative agents of gas gangrene are the anaerobic microbes emitting specific gas. These microbes instantly breed on devitalized muscles and wet wounds. The mephitic gangrene which incubation interval no more than two days, quickly extends and leads to severe intoxication of an organism. The wound becomes edematous, in soft tissues gas from microbes accumulates, there is a decomposition of muscles. The patient complains of rise in body temperature, sleeplessness, the lowering of arterial pressure and dehydration of an organism, tachycardia, breath increase, sometimes nausea is observed. When pressing edge of a wound from it vials of gas are allocated and the unpleasant putrefactive smell is felt. The condition of the patient quickly worsens, shock is possible. On X-ray "porosity" of muscular tissue is obviously looked through.
Treatment of gangrene:
Treatment of gangrene is directed, first of all, to improvement of functions of blood circulation and activity of cardiovascular system. For this purpose intravenously enter glucose, isotonic solution, blood substitutes, transfuse blood, plasma, appoint heart drugs. At extremity gangrene doctors try to recover in all ways blood circulation in the struck fabrics, the artery operations allowing to limit a zone of a necrosis are probable and as much as possible to keep musculoskeletal function of an extremity. After recovery of blood circulation delete dead fabrics.
If gangrene dry, then operation to the discretion of doctors can be postponed until full division of living and dead tissues. At the same time the struck area at dry gangrene sometimes will be amputated purely for the cosmetic reasons. If dry gangrene passes in wet, then an urgent operative measure is necessary: severe intoxication and fever force to carry out the emergency early amputation of an extremity within healthy fabrics for the purpose of rescue of life of the patient. The patient with gangrene of internals carries out an immediate chrevosecheniye and removal of the struck body.
At gas gangrene which develops immediately the emergency excision of a wound limits of healthy fabrics is also carried out. People with gas gangrene are subject to isolation and need special processing of linen, bedding and medical tools.