Modern possibilities for treating gangrene of the lower extremities in diabetic foot syndrome

The onset of old age is often accompanied by a deterioration in health; older people suffer from chronic diseases and their exacerbations. One of the most severe conditions that are diagnosed in old people is gangrene of the lower extremities. The disease is characterized by its insidiousness and rapid increase in symptoms, leads to disability of the sick person and can cause death.

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How to determine gangrene?

The symptoms of gangrene are reflected depending on the type of necrosis. Gangrene symptoms of the digestive system manifest themselves in the form of peritonitis. A person may experience signs of food poisoning and severe pain.

In a general sense, there are 2 main types - dry and wet gangrene . Separately, gas gangrene is distinguished.

signs of gangrene

Symptoms and complications

Areas affected by gangrene are usually warm and swollen.
The skin may be pale at first, but soon turns red or brown and finally greenish-black. The affected area may become severely scarred and require reconstructive surgery. If significant tissue death occurs, the affected body part may even need to be removed. Sometimes a brown liquid forms under the skin, causing large blisters to grow. If clostridia is the cause of gangrene, gas produced by the bacteria may be seen in these blisters.

Substances produced by bacteria are very toxic to human tissue and kill healthy cells by reducing oxygen levels. If the infection does not stop, these bacterial toxins will soon enter the bloodstream and begin to poison vital organs (so-called toxic shock), causing immediate kidney failure.

Gangrene: causes and symptoms

Dry gangrene spreads to the skin, fingers and toes. In case of impaired blood circulation and stagnation in the arteries, the tissues will receive the necessary nutrition. Symptoms of dry gangrene:

• The damaged part of the body is always colder than the healthy part.
• Over time, a person may lose sensitivity.

The patient's general condition remains stable, since there is no poisoning of the body. with this type of gangrene , but no one excludes the possibility of transformation into the wet form. If you contact a specialist in a timely manner, normal blood circulation can be restored and the need for amputation can be avoided. The main cause of the disease is the gradual occurrence of stagnation in the blood vessels.

Wet gangrene is very dangerous. Both types of gangrene have similar symptoms: cold extremities, lightening of the skin, lack of pulse. The beginning of the development of gangrene of the foot:

• A body part cannot move fully. The foot has indicators of cadaveric decomposition.
• General health is poor: the patient gets tired quickly and is weakened.
• To all of the above is added temperature, anemia, and decreased blood pressure.

Darkening of a certain part of the body, the appearance of an unpleasant odor. When you press on the affected area, you can hear a specific sound due to the accumulation of hydrogen sulfide.

diagnosis of gangrene

The most important thing is timely recognition of the symptoms of gas gangrene. In theory, it is similarly a wet gangrene, which is caused by certain bacteria and toxic substances.

An indicator that is specific to gas gangrene is poisoning and a rapid deterioration of the general condition, as the sending substances spread throughout the body, causing intoxication. The main reason for such infection is the penetration of microorganisms into wounds.

Causes

Impaired blood supply to tissues is now one of the most common causes of gangrene. In this case, the tissues do not receive enough oxygen and necessary nutrients, which leads to changes in their structure, and subsequently necrosis. The pathological condition can occur with the development of various peripheral arteries, as well as against the background of:

• Diabetes mellitus.
• Atherosclerosis.
• Oncological diseases.
• Diseases of the endocrine system.

Another common cause of gangrene is the activation of pathogenic microorganisms, most often bacteria. Against this background, tissue destruction and death occurs. As a rule, processes occur when the immune system is weakened and various infectious diseases develop. In particular, gas gangrene is caused by the anaerobic pathogen Clostridium.

Factors that provoke tissue necrosis include physical and chemical influences that lead to tissue damage. The pathological condition often occurs due to thermal, radiation or chemical injury.

Which symptoms should be given more importance?

The first signs of gangrene are severe pain, which can be eliminated exclusively with the help of analgesics. In addition, a change in skin color is considered a primary indicator. It is possible to establish the presence of gangrene in the internal organs due to the deterioration of the general condition.

The negative side will be the presence of diabetes mellitus, so patients with such pathology are advised to be more attentive and not turn a blind eye to the first signs. Damage to blood vessels, burns, radiation sickness play a negative role in the spread of gangrene of the arms , legs, and the like.

Prognosis after gangrene treatment

The clinical outcome that gangrene leads to depends on the condition of the internal organs (heart and kidneys) and the form of gangrene. The causes of soft tissue gangrene in most cases are associated with the processes of gradual blockage of blood vessels, which develops not only in the arteries of the legs, but also in other vascular systems (brain, heart, abdominal organs). Life expectancy after reconstructive vascular operations depends on possible vascular accidents in other areas (myocardial infarction or ischemic stroke), but it has been established that after amputation of one leg, 70% of patients die in the next two years, and after successful vascular operations, long-term mortality is not more than 10% per year.

How to properly treat gangrene?

The first thing you need to know is that self-medication can lead to dire consequences, so you should abandon this idea. No need to waste time, make an appointment with a doctor immediately.

An exceptionally experienced specialist will be knowledgeable about how gangrene on the arm can be cured, etc., and will therefore be able to prescribe treatment for you without the need for amputation.

gangrene treatment

To avoid negative consequences, it is necessary to restore normal blood circulation, so doctors prescribe minimally invasive endovascular operations on arteries and vessels to patients with gangrene on the arms and legs. In addition, specialists can resort to necrectomy, which will ensure that there is no need for amputation.

Hybrid surgery in the treatment of dry gangrene without amputation

This is the combined use of bypass surgery and angioplasty to solve the problem of restoring blood flow within a single intervention. Hybrid surgeries are performed in our clinic to achieve optimal clinical results for complex vascular lesions. They expand the possibilities of vascular surgery and allow us to save the leg in the vast majority of patients with gangrene. A shunt works well only when the artery above and below it is well patent. If there are atherosclerotic plaques and narrowings above or below the shunt, then blood stagnates in such a shunt and thrombosis occurs. A shunt to treat gangrene allows you to bypass long-term blockages in the arteries, and then by performing angiography and angioplasty below the shunt, we ensure unimpeded blood flow to the foot and toes. The use of such tactics allowed us to save the leg in 96% of patients with impending ischemia.

Symptoms of wet gangrene

• wet gangrene of the leg usually begins in an overweight, edematous elderly person;
• the skin is initially pale and cold, severe swelling is observed, the venous network is visible, the pulse in the arteries of the leg cannot be felt;
• dark red spots appear on the skin;
• inflammation progresses rapidly, there is no demarcation shaft between healthy and diseased areas;
• the affected tissues do not dry out, but turn black and decompose (there is a strong smell of rotting);
• decomposition products enter the bloodstream and severe intoxication occurs;
• the elderly person’s condition is very serious, he is bothered by intense pain and high fever; pulse is increased, blood pressure is low;
• the patient's refusal to eat and drink;
• spread of infection leads to sepsis and death.

How to get treatment

• Make an appointment with a leading specialist in the treatment of critical ischemia and gangrene, Ph.D. Kalitko Igor Mikhailovich, by phone (reception in Moscow on Saturdays).
• To consult directly at the clinic (in Klin) or to obtain information on emergency hospitalization, contact our chief physician Alexey Valerievich Sedov by phone.
• in a special section or use “Correspondence with a Doctor” to get preliminary consultation on documents and guidance on treatment methods and costs.
• You can make an appointment yourself using a special registration form, but the administrator will definitely call you back to confirm the appointment and clarify the reasons for your application.

Diagnostics

Diagnosis of gangrene is not difficult and includes:

• Inspection of the affected area (visual);
• Arterio- or phlebography;
• Ultrasound Doppler examination of blood vessels;
• Rheovasography;
• CT and MRI;
• Duplex scanning with contrast agent;
• General blood analysis;
• Blood chemistry;
• Bacteriological examination of biomaterial taken from the affected area.

A correct diagnosis can be made in all cases.

Prevention of gangrene in private nursing homes “Longevity”

In the Longevity boarding houses, elderly guests are provided with comprehensive services, including regular examinations by doctors, as well as a set of preventive measures to prevent the development of this serious illness. At the initial stage, the disease can be prevented or the process of necrosis can be stopped in time. Experienced boarding house specialists know how gangrene begins in the elderly, what it looks like, so they can easily detect not only the beginning of gangrene, but also its precursors by the symptoms.

In addition, our guests are provided with:

• full care and supervision for the elderly and sick 24 hours/7 days a week (for bedridden patients - special medical beds with anti-decubitus mattresses);
• 5-6 balanced meals a day (dietary meals are prescribed if necessary);
• comfort in the rooms, choice of accommodation (1, 2, 3-bed rooms);
• individual psychological assistance, organized leisure, walks, interest groups.

The boarding houses are located in quiet and cozy places in Moscow and the Moscow region (in Ramenskoye, Vidnoye, Zelenograd, Belozerki). All houses have their own fenced area with picturesque nature.

Our guests, no matter how severe their illnesses, do not feel lonely and abandoned. Here they always feel support, help and confidence in the future.

Sources

1. Bondarenko O.N., Ayubova N.L., Galstyan G.R., Dedov I.I. Transcutaneous oximetry in dynamic monitoring of patients with diabetes mellitus and critical ischemia of the lower extremities. Diabetes. 2013;16(1):33-42.
2. Mitish V.A., Paskhalova Yu.S., Ushakov A.A., Slepnev S.Yu., Mishurinskaya E.A. The role of disarticulation and guillotine amputation of the leg in the strategy of surgical treatment of ischemic gangrene of the lower limb. Wounds and wound infections. Journal named after prof. B.M. Kostyuchenka. 2020;7(1):26-35.
3. Barkhatova N.A., Abdulova Yu.B. Some clinical and laboratory risk factors for death in gangrene of the extremities. //Innovative science. - 2021. - No. 4.

What is this?

The circulatory system of the human body is designed in such a way that normally each cell is provided with oxygen and nutrients through the blood, and the blood takes carbon dioxide and waste products from the cell.
If for some reason, for example, due to blockage of a vessel, blood stops flowing into the tissues, they begin to die. In this case, necrosis develops gradually: first, sensitivity in the affected area is lost, the color changes to dark blue or almost black, the temperature in this area decreases, pulsation in the projection of large arteries disappears, and severe pain appears. The skin in the area of ​​gangrenous lesion gradually dries out and shrinks due to the folding of cellular proteins left without nutrition. Without timely treatment and elimination of the causes of gangrene, the affected area of ​​skin is gradually rejected. If necrosis affects internal organs, then their healthy tissue is replaced with connective tissue over time, and the organs cease to perform their functions.

Dry gangrene is spoken of as long as necrosis occurs without the participation of pathogenic microflora. When infection enters the affected tissue, wet gangrene develops, which releases toxins into the body. Therefore, dry gangrene has a better prognosis than wet gangrene, but both of these diseases are extremely dangerous for the health and life of the patient.

Dry gangrene, unlike its other types, does not spread to other organs and tissues: it begins in the place most distant from the point of blood flow disturbance and gradually reaches the place of compression or blockage of the blood vessel, which serves as the root cause of the disease. With dry gangrene, the border between dead and healthy tissue is always clearly defined, and the pathological process does not spread further.

The blackening of tissue in the area of ​​necrosis is caused by the accumulation of hemoglobin and the formation of salts from the iron released from it. Ferrous sulfate is used industrially to make ink and dye wool black.

Tissues with dry gangrene mummify and do not pose a threat to neighboring organs, so emergency surgery is not performed. The optimal time for surgical treatment is considered to be the moment a pronounced border appears between healthy and dead tissue (Fig. 1), this allows you to avoid affecting areas not damaged by necrosis.

Figure 1. Dry gangrene. Source: PHIL CDC