1.General information
Gas gangrene is one of the most severe forms of infection caused by anaerobic (living only in the absence of air) pathogenic microorganisms. Once upon a time, gangrene, being a rapidly progressing life-threatening condition, was one of the most common causes of death and loss of limbs, for example, in military field medicine, where in pre-antibiotic times the possibility of primary surgical treatment of wounds was very limited, and their infection, on the contrary, was almost guaranteed .
However, even today gas gangrene, with all its inherent threats, is encountered in traumatological, infectious-parasitological, general and vascular surgical practice, continuing to claim the lives of patients.
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PREVENTION
Here are some tips to help you reduce your risk of developing gangrene:
If you have diabetes, inspect your hands and feet daily for cuts, sores, and signs of infection such as redness, swelling, or discharge. Ask your doctor to examine your hands and feet at least once a year.
Carrying extra pounds not only increases your risk of developing diabetes, but it also puts pressure on your arteries, reducing blood flow and increasing the possibility of infection and slow wound healing.
Chronic use of tobacco products can damage blood vessels.
Wash open wounds with mild soap and water and try to keep them clean and dry while they heal.
Frostbite on the skin can lead to gangrene; frostbite reduces blood circulation in the affected area. If you notice that any area of your skin is pale, hard, cold, or numb after prolonged exposure to cold temperatures, consult your doctor.
2. Reasons
Of all the anaerobes that can cause gas gangrene, the most widespread and studied is the genus Clostridia - an opportunistic rod-shaped bacterium that is sown in approximately every fourth healthy person (it lives in the intestines, vagina, and is sometimes found in saliva and on the oral mucosa). Over ten of the most dangerous types of clostridia are known, the abnormally active activity of which leads to the development of gas gangrene in its various forms, and also causes botulism, severe diseases of livestock, etc.
Clostridia can develop, actively reproduce and secrete deadly toxins only in airless environments, i.e. They are obligate anaerobes - oxygen in the air is harmful to them. However, the spores they form are able to survive for quite a long time in the environment, and in the etiopathogenesis of gas gangrene, infection of the wound by soil is of great importance, especially if this soil contains cattle manure.
Dead organic matter serves as a breeding ground for pathogenic bacteria, so anaerobic gangrene can begin in almost any oxygen-free zone of the body, where necrosis develops for one reason or another. There is every reason to call this type of gangrene gas: the vital activity of anaerobic bacteria is accompanied by the intense release of not only toxins, but also gases.
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RISK FACTORS
Some factors that increase the risk of developing gangrene. These include:
- Age.
Gangrene is much more common in older people. - Diabetes.
If you have diabetes, your body doesn't produce enough of the hormone insulin (which helps cells get sugar from the blood) or your cells are resistant to the effects of insulin. High blood sugar can eventually damage blood vessels, cutting off blood flow to parts of your body. - Diseases of the blood vessels.
Narrowing and hardening of an artery (atherosclerosis) and blood clots can also block blood flow to a specific area of the body. - Severe injuries or surgery.
Any process that causes damage to the skin and underlying tissue, including injury or frostbite, increases your risk of developing gangrene, especially if you have an underlying medical condition that reduces blood flow to the injured area. - Obesity.
Obesity is often accompanied by diabetes and vascular disease, but the pressure of excess weight can also compress arteries, leading to reduced blood flow and increasing the risk of infection and poor wound healing. - Immunosuppression.
The body's ability to fight infection is impaired by human immunodeficiency virus (HIV) infection or after chemotherapy or radiation therapy. - Medicines.
In rare cases, the anticoagulant drug warfarin may cause gangrene, especially when combined with heparin therapy.
3. Symptoms and diagnosis
A common property of all types of gas gangrene is rapid spread and progression.
There are four main forms of gas gangrene:
- emphysematous (emphysema - “airing” of tissue), typical gas gangrene, practically without pus, but with widespread necrosis, violent gas formation (with a cadaverous odor) and visible tissue decay, incl. muscles;
- edematous-toxic (as the name implies, swelling and symptoms of general intoxication predominate);
- phlegmonous (diffused necrotic inflammation predominates);
- putrefactive, or putrid (rapid decay of muscle tissue, grayish color, purulent-putrefactive discharge with the release of sharp-smelling gases.
Intoxication is manifested by a significant decrease in blood pressure, tachycardia, altered state of consciousness (pathological excitation or, conversely, depression of the central nervous system), high body temperature (up to 39° and above, which is a prognostically unfavorable sign), impaired renal function, etc. In the absence of qualified and full-scale medical care, death inevitably occurs within the next 1-3 days.
Diagnosis is usually not particularly difficult: the history and dynamics of the condition are studied, the wound is examined, x-rays, blood and urine tests are prescribed (where gas gangrene reveals a complex of changes characteristic of it).
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FORECAST
Typically, people with dry gangrene have a better prognosis because dry gangrene is not associated with a bacterial infection and spreads more slowly than other types of gangrene. However, when infected gangrene is diagnosed and treated quickly, the likelihood of recovery is greater.
Older people, people who are immunocompromised or have underlying health conditions (such as diabetes, atherosclerosis, or some types of cancer), and those who seek medical help for advanced cases of gangrene are more likely to have complications from gangrene.
4.Treatment
Stopping the progression of gas gangrene is possible only by intensive surgical treatment of the wound with excision and removal of dead tissue (including healthy tissue). Powerful antibiotics are prescribed, hyperbaric oxygenation of the wound, drainage is applied, and the wound is left open. If, despite all efforts, the progression of gangrene cannot be stopped, the limb is urgently amputated. It is also necessary to take the most serious aseptic measures to avoid further spread of the pathogen (in particular, infection of medical personnel). Existing anti-gangrenosis serums, in general, do not yet live up to the hopes placed on them and, in addition, such vaccination is fraught with serious complications.
Symptoms of gangrene
The symptoms of gangrene are extremely specific and cannot be confused with manifestations of other diseases and disorders.
Dry gangrene, which is most characteristic of vascular etiology, is not life-threatening. The affected tissues do not disintegrate, but become mummified - they dry out, losing fluid. Toxic substances are released in moderate quantities, and the body manages to inactivate them. The focus of necrotic lesion is clearly organic and distinguishable. Wet gangrene is characterized by intense and aggressive coverage of tissue structures, very rapid progression, and infection of the systemic bloodstream by poisons released during necrosis. This condition often becomes a consequence of an infectious process and poses a direct threat to the patient’s life.
Common symptoms of gangrene of the hands or feet:
- A sharp and severe attack of pain in the affected limb;
- Fading of the cover and its subsequent coloring in a marble shade;
- Reduction (in the dry form) or increase (in the wet form) of the limb in size;
- Complete loss of sensitivity in the affected tissues;
- Dyeing fabrics dirty gray (when wet) or blue-black (when dry);
- The appearance of a persistent putrid odor (in the wet form) / clear limitation of dead tissue (in the dry form).
The difference lies in the general well-being of the patient. With the wet form of gangrene, it rapidly worsens - symptoms of extensive intoxication appear, the pulse weakens, and chills are observed. With dry gangrene, such symptoms do not occur. The affected limb often detaches on its own.
Establishing diagnosis
Gas gangrene is characterized by a necrotizing (flesh-destroying) bacterial infection that can be recognized by a doctor. The doctor will take a tissue sample or perhaps some fluid from the blisters. The sample is tested in the laboratory. However, treatment will not wait for results. The doctor will immediately begin giving you a broad-spectrum antibiotic.
If the infection is severe, sometimes an X-ray or MRI of the soft tissue is used to detect gas deep under the skin. If surgery is required, these scans will indicate exactly where the bacteria are and what needs to be removed.
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.
Photos of gangrene and its treatment
Questions and answers
Limited necrosis of the big toe of the right foot Hello!
Initially, I hit my toe on a step in the dark) I initially applied iodine to the bruise, but it didn’t help that the toe began to swell and twitch for a month.. I went to a paid clinic: Examination by a surgeon - he says it looks like an ingrown toenail, I... Answer:
Call me back on the phone
gangrene
Hello! I would like to know from you! My grandmother, she is 84 years old, gangrene of her left leg began, she had surgery on blood vessels at the Gorbacheva Pathological Clinic in St. Petersburg, but nothing good was done...
Answer:
We are doing this successfully.
Send research data, a medical statement and a photograph of your leg in the “Correspondence with the Doctor” section. It is advisable to do this as quickly as possible, as gangrene progresses. Can you come to the nearest one... gangrene or something else?.....
Hello! My father has this problem. 3 6 days ago I tore off a callus on my toe, the toe turned blue with a bruise, went to the surgeon for a dressing, the ichor began to come out, the leg...
Answer:
Urgently see a vascular surgeon and be sure to do an ultrasound of the blood vessels.
Atherosclerosis and gangrene,
hello, my father (71 years old) has atherosclerosis of the vessels of the arteries of the lower extremities, gangrene has started on the right toe, there are pictures, tests, we hoped for an operation, but we were told that it was too late to save the leg...
Answer:
It is necessary to send ultrasound data of the arteries and photographs of the leg in the “Correspondence with the doctor” section….
Diabetic foot gangrene,
my husband had a black spot on the right foot of the big toe, not so quickly the floor of the foot became dark purple, they were admitted to surgery for treatment with a diagnosis of wet gongrene of the lower extremity...
Answer:
We deal with such pathology.
Bring the patient directly to the clinic for a consultation; if space and indications are available, we will hospitalize him. Contact the chief physician A.V. Sedov. regarding hemodialysis and places... gangrene of the big toe of the lower extremities
Hello. I am 35 years old. On April 30, 2014, I had surgery to ligate the femoral artery. I can’t walk, there is swelling on the lower leg, there is no sensation in the foot. Ultrasound showed phlebitis of the superficial and deep veins of the lower extremities, endarteritis arteries n/c with nk 3rd degree. I have unbearable pain, I can’t sleep. Appeared...
Answer:
Come to the clinic urgently, we have every opportunity to help.
Amputation at 35 years old, maybe. produced only in a hopeless condition. Phone number of the chief physician Alexey Valerievich Sedov... critical ischemia of the lower extremities
Good afternoon! Dad is 75.5 and has diabetes. Currently, he was treated in surgery, the diagnosis was polyneuropathy, critical ischemia of the lower extremities. The feet burn, the joints on them become inflamed, abscesses form under...
Answer:
You need to contact a surgeon, this is their job
Leriche Gangrene Syndrome
Hello! My father (57 years old) was diagnosed with Leriche syndrome. Due to gangrene, three toes of the right foot were amputated, starting with the big one. At the moment they say that there are no other options other than amputation...
Answer:
Send medical reports on blood vessels, ECHO data, photographs of legs.
We may be able to perform endovascular treatment. Gangrene of the legs
Good afternoon. My father is 84 years old. He is diagnosed with gangrene. Doctors refuse to perform surgery, citing his age and health. Now he is being treated with medication - they give him IVs, pain-killing injections and apply ointments to his foot, but his condition has improved, his leg...
Answer:
Send in the “Correspondence with the Doctor” section photographs of your leg and ultrasound data of the arteries.
After that I will be able to answer this question for you... Gagrene in the legs of a 75-year-old grandmother after a heart attack
Hello!!! I want to ask you, my grandmother was admitted to the hospital with gangrene of her leg and we were told that it was necessary to amputate the leg above the knee. She is after a heart attack and she is 75 years old. Costs…
Answer:
There are 2 treatment options: reconstructive surgery on blood vessels (bypass surgery or stenting through a puncture), or amputation for health reasons.
