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Gangrene

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ICD-10	A48.0, E10.5-E14.5, I70.2, I73
ICD-O:	{{{ICDO}}}
ICD-9	040.0, 785.4
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Warning: This article contains photographs that some people may find disturbing.

Gangrene is necrosisand subsequent decay of body tissuescaused by infectionor thrombosisor lack of bloodflow. It is usually the result of critically insufficient blood supply sometimes caused by injury and subsequent contamination with bacteria. This condition is most common in the extremities. The best of all possible treatments is revascularization(restoration) of the affected organ, which can reverse some of the effects of necrosis and allow healing. Depending on the extent of tissue loss and location, treatment other than revascularization runs the gamut from allowing digits to auto-amputate(fall off), debridementand local care, to amputation, the removal of infected necrotictissues.

Inhaltsverzeichnis

1 Types
2 History
3 Pathophysiology
- 3.1 Wet gangrene
- 3.2 Dry gangrene
4 Gas Gangrene
5 See also

Types

Image:Gangrene early-01.jpg Gangrene caused by a serious bacterial infection is called wet gangrene.
Gangrene caused by lack of circulation in an injured or diseased area is called dry gangrene.

One specific example of gangrene is so called diabetic foot that can be seen in long-standing complicated diabetes. It is caused by a combination of arterial ischemia, injury and poor healing that is rather common in diabetics. It often combines poor healing with a superimposed infection. The picture here is of a foot with a recent amputation of a great toe and yet increasing loss of circulation (the bluish area) with subsequent tissue loss to come. The most common surgical treatment for irreversible gangrene is immediate amputation, as the infection grows 2 to 3 cm per hour.

History

In the years before antibiotics, flymaggotswere commonly used to treat chronic wounds or ulcersto prevent or stop necrotic spread. Some species of maggots consume only dead flesh, leaving nearby living tissue unaffected. Their use largely died out after the introduction of antibioticsand enzymetreatments for wounds. In recent years, however, maggot therapyhas regained some credibility and is sometimes employed to great effect in cases of chronic tissue necrosis. See maggot therapyfor more information.

Pathophysiology

Wet gangrene

Image:AUTOAMPUTATE1.JPG Wet gangrene is perhaps the more familiar of the two types, at least in media portrayals. An injury, such as a gunshotor laceration, leads to a bacterialinfection, which produces pus. If the pus does not drain well, the blood supply to the area is blocked, and with it, the oxygen. With its oxygen supply cut off, the tissue dies.

Treatment of the underlying infection is necessary, as is removal of the dead tissue. Without treatment, the infection can spread further and destroy increasing amounts of tissue. Eventually, sepsisand death can result.

Dry gangrene

Image:ULCERCELLULITIS1.JPG If the blood flow is interrupted for a reason other than severe bacterial infection, the result is a dry gangrene. Persons with impaired peripheral blood flow, such as diabetics, are at greater risk for dry gangrene.

The early signs of dry gangrene are a dull ache and sensation of coldness in the area, along with pallorof the flesh. If caught early, the process can sometimes be reversed by vascular surgery. However, if necrosis sets in, the affected tissue must be removed just as with wet gangrene.

Gas Gangrene

Gas gangrene is a bacterial infection that produces gas within tissues in gangrene. It is a deadly form of gangrene usually caused by Clostridium bacteria. It is a medical emergency.

Gas gangrene can cause myonecrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid.

Pathophysiology-

Gas gangrene is caused by exotoxin producing clostridial species (most often Clostridium perfringens), which is mostly found in soil, and other anaerobes (e.g. Bacteroides and anaerobic streptococci). These environmental bacteria may enter the muscle through a wound and go on to proliferate in necrotic tissue and secrete powerful toxins. These toxins destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen and 16.1% oxygen was reported in one clinical case.[1]

Treatment-

Treatment is usually surgical debridement and excision with amputation necessary in many cases. Antibiotics alone are not effective because they don't penetrate ischemic muscles enough to be effective. However penicillin is given as an adjuvant treatment to surgery. In addition to surgery and antibiotics hyperbaric oxygentherapy (HBO) is used and acts to inhibit the growth of and kill the anaerobic C. perfringens. [edit]