What is gangrene
We talk about gangrene to indicate the death of a tissue or the decomposition of a part of the body following a blockage / lack of blood flow. The causes of gangrene are multiple and must be sought mainly in ischemia (due to embolisms or thrombi), bacterial infections, freezing or structural changes of veins and arteries induced by pathologies such as diabetes or atherosclerosis.
- Dry cancer, typical complication of diabetes and atherosclerosis in which we witness the progressive shrinkage (mummification) of the affected limb / tissue; the cause is mainly of ischemic type without bacterial proliferation
- Wet (wet) cancer, caused by a bacterial infection that spreads inside the body starting from an open wound and not properly treated; the cause is mainly of ischemic type resulting in bacterial proliferation
- Gaseous cancer, induced by the proliferation of toxins produced by bacteria that live in the intestine and in the ground and that can infect tissues damaged by a wound
Signs and Symptoms
How to notice gangrene? First of all it should be pointed out that the symptoms depend both on the type of gangrene (dry, wet, gaseous), and on the tissue / organ involved.
When the skin or limb is involved (eg diabetic foot), gangrene is revealed with symptoms such as:
- Skin color alteration: the skin takes on a bright red, brownish, greenish or black tint
- The tissue is swollen, soft and rotten (typical clinical picture of wet gangrene)
- The limb is dry, black and withered, almost mummified (characteristic condition of dry gangrene)
- Foul, foul-smelling odor from the tissue involved (wet gangrene)
- Loss of sensitivity in the area affected by gangrene: this event usually occurs following a strong trauma or pain in the affected area
- Infected, purulent and / or bleeding wound
When the infection is internal to the body (gas gangrene), the symptoms are different:
- Confusion and general malaise
- Persistent generalized pain
- Temperature
- Hypotension
- Presence of gas in the subcutaneous tissues
- Rapid breathing
- Septicemia (spread of infection in the blood)
- Tachycardia
Diagnosis
The diagnosis of gangrene is based first of all on the anamnesis (clinical history reported by the patient) and on the direct medical observation of the tissue presumably affected by necrosis. The physical examination is generally supported by a series of assessment tests, such as: blood tests (which, in the presence of gangrene, show an increase in white blood cells), radiographs and imaging studies (TAC and / or NMR, to determine the extent of the damage suffered).
In patients with dry gangrene, an arteriogram is generally performed, essential to identify with certainty the obstructed artery responsible for the symptoms.
A biopsy of infected tissue or purulent fluid emitted from the wound may be necessary to identify the bacteria involved in the infection.
Care and intervention
Gangrenous patients require urgent medical evaluation and adequate and timely treatment to avoid complications, such as generalized spread of infection (in the presence of wet and gaseous gangrene).
Patient hospitalization is always essential in case of confirmed gangrene.
The treatments of choice for curing gangrene and saving the unfortunate from bad luck are essentially surgery (removal of necrotic tissue or amputation of the affected limb) and aggressive antibiotic therapy.
The GANGRENA SECCA requires the restoration of the blood supply in the gangrenous zone: the intervention of a vascular surgeon is therefore the only solution that can save the limb and the life of the patient when the gangrene has not yet spread. In the most serious cases, that is when the gangrene has progressed to the point that the blood supply cannot be restored, the only life-saving solution is the amputation of the diseased limb.
The patient with MOIST CANCER should be treated with analgesics, which are essential to mask the atrocious pain caused by the infection. In addition to this therapy, wet gangrene requires the administration of broad-spectrum intravenous antibiotics. The drugs most used for this purpose are penicillin, metronidazole and aminoglycosides. To support the antibiotic treatment, the patient is generally subjected to surgical removal of the gangrenous tissue (surgical debridement).
Also in this case, amputation may be a possible option when gangrene cannot be controlled either by surgery or by antibiotics.
Constituting a real threat to the patient's life, GANGRENA GASSOSA must be treated aggressively with surgical removal of the infected tissue supported by an intravenous antibiotic treatment, essential to prevent septicemia.
When gangrene is diagnosed at an advanced stage, the patient (when he survives) may be subjected to alternative and supportive therapy:
- To accelerate the healing of gangrene induced by infected wounds, the patient is sometimes treated with the administration of growth factors, hormones and skin grafts
- Some patients suffering from gaseous gangrene are treated by hyperbaric oxygen therapy, a particular medical practice capable of providing higher levels of oxygen than the norm: by doing so, the growth of anaerobic bacteria is inhibited and wound healing is encouraged.
- An alternative and bizarre cure is Maggot's therapy, which consists in the introduction of live worms or fly larvae in the open and necrotic wound, in order to clean it from the bacteria involved in the infection.
Prevention in the diabetic patient
Patients most at risk of dry gangrene, or those suffering from diabetes, must pay extreme attention to the care and observation of their body. Diabetics in particular should be aware of the behavior to be followed to prevent infections in general, foot trauma and dry gangrene.
The feet of diabetics should always be adequately controlled by a second person - be it a family member or a doctor - who ascertains the absence of skin lesions. We remember, in fact, that in the presence of diabetes, scarring is much slower and patients struggle to realize trauma due to the progressive loss of sensitivity to the feet. As a result, failure to recognize a lesion (even minimal as a small callus) could degenerate into bleeding ulcers, leading to - in extreme cases - gangrene.
