Gangrene – Treatment – NHS

Treatment for gangrene involves removing the affected tissue, preventing infection or treating any existing infection, and treating the problem that led to gangrene developing.

For example, if gangrene is caused by a poor blood supply, surgery may be used to repair damaged blood vessels. If gangrene is caused by an infection, strong antibiotics may be used as well as surgery.

Removing dead tissue

Surgery to cut out the dead tissue, known as debridement, is often necessary to prevent the gangrene from spreading and to allow the surrounding healthy tissue to heal.

Larval debridement therapy (biosurgery)

In some cases, it may be possible to use larval debridement therapy, also known as biosurgery, instead of conventional surgery to remove the dead tissue.

Certain types of fly larvae are ideal for this because they feed on dead and infected tissue but leave healthy tissue alone. They also help fight infection by releasing substances that kill bacteria and stimulate the healing process.

Maggots used for larval therapy are specially bred in a laboratory using eggs that have been treated to remove bacteria. The maggots are placed on the wound and covered with gauze, under a firm dressing, which keeps them on the wound (and out of sight). After a few days, the dressing is cut away and the maggots are removed.

Medical studies have shown larval debridement therapy can achieve more effective results than surgical debridement. However, because of the nature of this type of treatment, many people are reluctant to try it.

Amputation

In severe cases of gangrene, where a whole body part, such as a finger, toe, or limb, is affected and debridement is unlikely to help, amputation may be considered.

Amputation can prevent gangrene spreading to other parts of the body and can be used to remove a severely damaged limb so an artificial (prosthetic) limb can be fitted.

Unless immediate emergency treatment is needed, a decision to amputate will only be made after a full discussion between you and the health professionals treating you.

Treating infection

Gangrene that’s caused by an infection can usually be treated with antibiotics, which can be given as tablets or injections.

Injections are usually necessary if you need surgery or you have a severe infection. Injecting antibiotics directly into a vein allows larger doses to be given and means that they’re more likely to reach the affected area.

To counter the effects of infection and accelerate the healing process, you’ll also need fluids and nutrients into a vein (intravenous fluids) and you may need blood transfusions.

Restoring blood flow

In some cases, surgery may be carried out to restore the blood flow to the affected area. The main techniques used to achieve this are:

• bypass surgery – where the surgeon redirects the flow of blood and bypasses the blockage by connecting (grafting) one of your veins to a healthy part of an artery
• angioplasty – where a tiny balloon is placed into a narrow or blocked artery and is inflated to open up the vessel; a small metal tube, known as a stent, may also be inserted into the artery to help keep it open

Research suggests that both techniques are equally effective in restoring blood flow and preventing the need for amputation in the short-term. An angioplasty has the advantage of having a faster recovery time than bypass surgery, although it may not be as effective in the long-term as bypass surgery.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy is an alternative treatment for some types of gangrene.

During hyperbaric oxygen therapy, you sit or lie down in a specially designed chamber filled with pressurised air. A plastic hood that provides pure oxygen for you to inhale is placed over your head.

This treatment results in high levels of oxygen being dispersed into your bloodstream and reaching the affected areas (even those with a poor blood supply), which speeds up healing.

For gangrene caused by a bacterial infection, the oxygen can also stop some types of bacteria (particularly the type responsible for gas gangrene) producing the toxins that allow the infection to spread, preventing further tissue damage.

Hyperbaric oxygen therapy has proved effective in treating gangrene caused by infected diabetic foot ulcers, reducing the risk of amputation.

However, evidence relating to the effectiveness of hyperbaric oxygen therapy in treating other types of gangrene is limited and further research is required. Hyperbaric oxygen therapy also isn’t currently widely available in the UK.

Reconstructive surgery

Reconstructive surgery using a skin graft may be used to cover the area of skin damaged by gangrene.

During a skin graft, the surgeon will remove healthy skin from another part of your body (usually a part that would be covered by clothing), and reconnect it over the damaged area.

Page last reviewed: 16 August 2018
Next review due: 16 August 2021

Gangrene – Diagnosis and treatment

Diagnosis

Tests used to help make a diagnosis of gangrene include:

• Blood tests. An abnormally high white blood cell count is usually a sign of infection. Your doctor might also order blood tests to look for the presence of specific bacteria or other germs.
• Fluid or tissue culture. Tests of the fluid from a blister on your skin may be examined for bacteria that can cause gangrene. Your doctor may look at a tissue sample under a microscope for signs of cell death.
• Imaging tests. X-rays, computerized tomography (CT) scans and magnetic resonance imaging (MRI) scans can show your organs, blood vessels and bones. Your doctor can use the results of these tests to determine how far the gangrene has spread throughout your body.
• Surgery. Surgery may be done to get a better look inside the body and learn how much tissue is infected.

Treatment

Tissue that has been damaged by gangrene can’t be saved, but steps can be taken to prevent gangrene from getting worse. The faster you get treatment, the better your chance for recovery.

Treatment for gangrene may involve medication, surgery or hyperbaric oxygen therapy — or a combination of these therapies — depending on the severity of your condition.

Medications

Medications to treat a bacterial infection (antibiotics) are given through an IV or taken by mouth.

Pain medications may be given to relieve your discomfort.

Surgery or other procedures

Depending on the type of gangrene you have and its severity, you may need more than one surgery. Surgery for gangrene includes:

• Debridement. This type of surgery is done to remove the infected tissue and stop the infection from spreading. Your doctor may also perform surgery to repair any damaged or diseased blood vessels to restore blood flow to the infected area. Your doctor may prescribe certain antibiotics until the infection is cleared.
• Amputation. In severe cases of gangrene, the infected body part — such as a toe, finger, arm or leg — may need to be surgically removed (amputated). You may later be fitted with an artificial limb (prosthesis).
• Skin grafting (reconstructive surgery). Sometimes, surgery is needed to repair damaged skin or to improve the appearance of gangrene-related scars. Such surgery may be done using a skin graft. During a skin graft, your doctor removes healthy skin from another part of your body — usually a place hidden by your clothing — and carefully spreads it over an affected area. The healthy skin may be held in place by a dressing or by a couple of small stitches. A skin graft can be done only if there is enough blood supply to the area.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy is done inside a chamber pressurized with pure oxygen. You usually lie on a padded table that slides into a clear plastic tube. The pressure inside the chamber will slowly rise to about 2.5 times normal atmospheric pressure.

When you’re safely exposed to increased pressure and oxygen, your blood can carry more oxygen. Oxygen-rich blood slows the growth of bacteria that live in tissue lacking oxygen and helps infected wounds heal more easily.

The treatment for gangrene generally lasts about 90 minutes. You may need two to three treatments every day until the infection clears.

Preparing for your appointment

Call your doctor right away if you have symptoms of gangrene. Depending on the severity of your symptoms, you may be told to go to the emergency room or to call 911 or your local emergency number for medical help.

If you have time before you leave home or on the way to the hospital, use the information below to get ready for your medical evaluation.

What you can do

• Write down any symptoms you’ve been experiencing and for how long. It will help your doctor to have as many details as possible about when your symptoms first appeared and how they may have worsened or spread over time.
• Write down any recent injury or trauma to your skin, including cuts, bites, injections, surgery or possible frostbite. If you have recently used injectable recreational drugs, this is critical information to share with your doctor.
• Write down your key medical information, including any other conditions with which you’ve been diagnosed. Also write down all medications, vitamins or supplements that you’re taking.
• Take a family member or friend along. Gangrene is a medical emergency. Take someone with you to help you remember all the information your doctor provides. You’ll also want someone who can stay with you if you need immediate treatment.
• Write down questions to ask your doctor.

For gangrene, some basic questions to ask your doctor include:

• What’s the most likely cause of my symptoms or condition?
• What kinds of tests do I need?
• Do I need to be hospitalized?
• What treatments do I need?
• How soon do you expect my symptoms to improve with treatment?
• Will I have a full recovery? If so, how long will recovery take?
• Am I at risk of long-term complications?

Don’t hesitate to ask your doctor any additional questions you have.

What to expect from your doctor

Your doctor is likely to ask you several questions to help determine the next steps in making your diagnosis and starting care. Your doctor may ask:

• What are your symptoms?
• When did you first begin experiencing symptoms?
• How painful is the affected area?
• Do your symptoms seem to be spreading or getting worse?
• Have you had any recent injuries or trauma to your skin, such as cuts, wounds, bites or surgery?
• Have you recently had any prolonged exposure to extreme cold that made your skin change color or turn numb?
• Do you use injectable drugs, including recreational drugs?
• Have you been diagnosed with any other medical conditions?
• What medications are you taking or have recently taken, including prescription drugs, over-the-counter medications, herbs and supplements?

Feb. 11, 2021

Symptoms, Causes, Diagnosis, Treatment, and Prevention

What Is Gangrene?

Gangrene happens when tissues in your body die after a loss of blood caused by illness, injury, or infection. It usually happens in extremities like fingers, toes, and limbs, but you can also get gangrene in your organs and muscles. There are different types of gangrene, and all of them need medical care right away.

Gangrene Risk Factors

Any condition that affects your blood flow increases your chances of getting gangrene, including:

Gangrene Types

There are two main types of gangrene:

Dry gangrene: This is more common in people who have vascular disease, diabetes, and autoimmune diseases. It usually affects your hands and feet. It happens when something — often, poor circulation — blocks blood flow to a certain area. As your tissue dries up, it changes color. It may be brown to purplish-blue to black. The tissue often falls off. Unlike with other types of gangrene, you typically don’t have an infection. But dry gangrene can lead to wet gangrene if it becomes infected.

Wet gangrene: This type almost always involves an infection. Burns or trauma in which a body part is crushed or squeezed can quickly cut off blood supply to the area, killing tissue and raising the odds of infection. The tissue swells and blisters; it’s called “wet” because it causes pus. Infection from wet gangrene can spread swiftly around your body.

Types of wet gangrene include:

Internal gangrene: This is gangrene that affects your internal organs. It’s usually related to an infected organ such as your appendix or colon.

Gas gangrene: Gas gangrene is rare but especially dangerous. It happens when you get an infection deep inside your body, such as inside muscles or organs, usually because of trauma. Bacteria called clostridia release dangerous toxins or poisons, along with gas that can be trapped in your tissue. Your skin may become pale and gray and make a crackling sound when pressed. Without treatment, gas gangrene can be deadly within 48 hours.

Fournier’s gangrene: Also a rare condition, Fournier’s gangrene is caused by an infection in your genital area. It affects men more often than women. If the infection gets into your bloodstream, a condition called sepsis, it can be life-threatening.

Progressive bacterial synergistic gangrene (Meleney’s gangrene): This type usually causes painful lesions on your skin 1 to 2 weeks after surgery or minor trauma. It’s also rare.

Gangrene Symptoms

Dry gangrene symptoms include:

• Shriveled skin that changes from blue to black and eventually comes off
• Cold, numb skin
• Pain

Symptoms of wet gangrene include:

• Swelling and pain
• Fever and feeling unwell
• Red, brown, purple, blue, greenish-black, or black skin
• Blisters or sores with a bad-smelling discharge (pus)
• A crackling noise when you press on the affected area
• Thin, shiny, or hairless skin
• A line between healthy and damaged skin

Internal gangrene causes severe pain in the affected area. For example, if you have gangrene in your appendix or colon, you’d probably have belly pain. Internal gangrene can also cause a fever.

Gangrene Diagnosis

Your doctor will ask about your symptoms and medical history. You may have:

• Blood tests. These look for bacteria or check for signs of infection, like more white blood cells than usual.
• Imaging tests. CT and MRI tests tell your doctor whether your gangrene has spread and if gas has built up in your tissues. In an arteriogram, your doctor injects dye into your blood and then takes an X-ray to check blood flow and look for blocked arteries.
• Cultures. Your doctor might take a sample of blood, fluid, or tissue, and look at it under a microscope for signs of bacteria or tissue death.
• Surgery. This can confirm internal gangrene or tell your doctor whether gangrene has spread.

Gangrene Complications

If an infection gets into your blood, you may get sepsis and go into septic shock. This needs treatment right away. Symptoms include:

• Low blood pressure
• Rapid heartbeat
• Shortness of breath
• Change in body temperature
• Light-headedness
• Body pain and rash
• Confusion
• Cold, clammy, pale skin

Gangrene Treatments

Treatment for all forms of gangrene involves removing dead tissue, treating and stopping the spread of infection, and treating the condition that caused the gangrene. The sooner you get treatment, the more likely you are to recover.

Your treatment depends on the type of gangrene and may include:

Surgery. This is also called debridement. Your doctor removes dead tissue to keep the infection from spreading. They might need to remove an affected limb, finger, or toe (amputation).

Maggot therapy. Believe it or not, maggots still play a role in modern medicine. They’re a nonsurgical way to remove dead tissue. Your doctor puts maggots from fly larvae (specially bred in a lab so they’re sterile) on your wound, where they eat dead and infected tissue without hurting healthy tissue. They also help fight infection and speed healing by releasing chemicals that kill bacteria.

Antibiotics. You might get antibiotics through a needle (called intravenous, or IV) to treat or prevent infection.

Oxygen therapy. Hyperbaric oxygen therapy can treat wet gangrene or ulcers related to diabetes or peripheral artery disease. You spend time in a special chamber filled with oxygen at a higher pressure than oxygen found in the outside air. Experts think this high level of oxygen fills your blood and speeds tissue healing. Oxygen therapy may also slow the growth of bacteria.

So that you don’t get gangrene again, your doctor will need to find out what’s blocking your blood supply and treat that condition. You might need vascular surgery, such as bypass surgery or angioplasty, to restore blood flow. You might also take medication to prevent blood clots.

Gangrene Prevention

The best ways to prevent gangrene are to:

• Manage your health conditions. If you have diabetes, keep your blood sugar levels under control. Check your hands, feet, and legs regularly for signs of injury, slow wound healing, or other skin problems. Follow your doctor’s advice on living with other conditions that affect your blood flow like peripheral artery disease or Raynaud’s phenomenon.
• Watch your wounds. Get medical care right away if you see signs of infection.
• Don’t smoke.Tobacco can damage your blood vessels.
• Keep a healthy weight. Extra pounds can put pressure on your arteries, blocking blood flow.
• Stay warm. Frostbite also blocks blood flow and can lead to gangrene.

Gangrene: Symptoms, Causes, Treatments

Overview

What is gangrene?

Gangrene is a serious medical condition in which lack of blood supply to body tissues causes the tissue to die. Although any body tissues can be affected, gangrene most commonly starts in the fingers, toes, hands and feet.

Gangrene can be fatal if left untreated.

There are several different types of gangrene including:

• Dry gangrene: Tissue death results when blood flow to an area is disrupted or becomes blocked, often due to poor circulation.
• Wet gangrene: Tissue death results from a bacterial infection and injury that cuts off the blood supply. Tissue swells, blisters, and pus (the “wet” factor) develops. Wet gangrene can quickly spread and therefore requires immediate medical attention.
• Gas gangrene: Tissue death results from an infection caused by the bacteria Clostridium. The bacteria quickly multiply inside body tissues, forming toxins and releasing gas in the tissue. If left untreated, gas gangrene can quickly lead to death.
• Fournier’s gangrene: This gangrene is caused by an infection to the penis, scrotum or perineal (genital and anal) area.
• Internal gangrene: This gangrene is due to blocked blood flow specifically to internal organs, such as the intestines, gallbladder or appendix.

Who is at risk for gangrene?

Gangrene is more likely to develop in individuals who have:

• Atherosclerosis or peripheral arterial disease: In these conditions, fat deposits in the arteries restrict blood flow.
• Diabetes: Diabetes damages nerves and blood vessels. Diabetes causes wounds to heal more slowly. Slow healing wounds are at increased risk for infection. Feet are especially at risk for infection as a complication of diabetes.
• Raynaud’s syndrome: In this condition, blood vessels in the fingers and toes react abnormally to cold temperatures. The blood vessels constrict (narrow) causing a decrease in blood flow to these digits.
• Serious injuries to skin and tissues – such as from burns, frostbite, trauma (e.g. resulting in a crushed or squeezed body part): These injuries cause loss of blood to the area, tissue damage and increased risk of infection.
• Weakened immune system: Even minor infections can lead to gangrene in individuals with weakened health status (for example, from such causes as diabetes, cancer, infectious diseases, alcoholism/drug abuse, older age).

Symptoms and Causes

What causes gangrene?

Gangrene is tissue death that results from lack of blood supply to the affected tissue area. Blood flow to all of the body’s tissues is vital to life. Blood delivers oxygen, nutrients and antibodies to fight infection. If the blood supply is cut off, cells can die, infections can develop, and tissue can die from gangrene.

Gangrene occurs as a result of an injury, infection in tissue or other conditions that affect blood circulation.

What are the signs and symptoms of gangrene?

The symptoms of gangrene vary depending on the cause. General symptoms include:

• Cold, pale skin.
• Loss of feeling in the affected area.
• Pain may or may not be present in the affected area.
• Red and swollen skin in the affected area.

If a bacterial infection causes gangrene, other signs and symptoms may also include:

• Fever.
• Chills.
• Loss of appetite.
• Rapid breathing and heartbeat.
• Dizziness.
• Severe pain in the affected area.
• Sores and blisters that bleed and release foul-smelling pus.
• Crackling sound when pressing on the skin (indicates a buildup of gas in tissue).
• Change in skin color as it dies — from red to brown to purple to black.

Diagnosis and Tests

How is gangrene diagnosed?

Your doctor diagnoses gangrene by examining your skin, taking your medical history and ordering tests, including:

• Circulation studies to check blood flow to the affected area of the body.
• Blood work to check for infection.
• Blood, fluid, or tissue cultures to determine the specific bacteria involved (if bacteria are involved) and best antibiotic to treat the bacterial infection.
• Imaging tests, such as computed tomography (CT) or magnetic resonance imaging (MRI), to confirm gangrene location and spread, identify gas gangrene, identify blockage of blood flow.
• Surgery to confirm gangrene and to treat it.

Management and Treatment

How is gangrene treated?

The goals of gangrene treatment are to:

1. Remove dead or infected tissue.
2. Prevent or treat infection to keep gangrene from spreading.
3. Treat the underlying conditions that caused gangrene to develop.

Removing dead tissue

Dead tissue can be removed through traditional surgery or by a type of biosurgery called larval debridement therapy. This type of therapy uses maggots that do not reproduce. These laboratory-bred maggots are placed on the wound, which is then covered with a dressing. The maggots feed on dead tissue only; leaving healthy tissue alone. After a few days, the dressing and maggots are removed.

Amputation of the affected finger, toe or limb is sometimes the only option if gangrene is severe and removal of the dead tissue is unlikely to prevent its spread.

Restoring blood flow

In some cases, doctors surgically repair blood vessels. The repaired vessels allow blood flow to reach the area affected by gangrene so that the tissue can recover and to prevent gangrene from occurring again.

Treating the infection

If a bacterial infection causes gangrene, doctors prescribe antibiotics to treat and prevent infection.

Other treatments

Other treatments such as hyperbaric oxygen therapy (HBOT) may also be used. During HBOT, you are enclosed inside a high-pressure oxygen chamber. High levels of oxygen circulate through body tissues, helping to heal dying tissue. The high oxygen content may also help decrease bacterial growth that relies on oxygen to grow and spread.

What complications are associated with gangrene?

Left untreated, gangrene may progress to a serious blood infection called sepsis. Sepsis may cause complications including organ failure, extremely low blood pressure, changes in mental status, shock and death.

Prevention

Can gangrene be prevented?

For people living with circulatory system issues or diabetes, the best way to prevent gangrene is to keep blood glucose levels within the normal range and to regularly check your feet and legs for any signs of injury or skin breakdown. Early diagnosis of these problems allows treatment to begin before gangrene develops.

Other ways to help prevent gangrene include quitting smoking, avoiding alcohol, eating a healthy diet and exercising regularly.

Outlook / Prognosis

What is the prognosis (outlook) for people with gangrene?

The prognosis for people with gangrene depends on the cause. Early diagnosis and treatment are the keys to a successful recovery.

Living With

When should I call my doctor?

Contact your doctor if you have a wound or infection that gets progressively worse, or if you experience any of the symptoms of gangrene. Early treatment helps prevent serious complications.

How to Treat Gangrene: 9 Steps (with Pictures)

About This Article

Co-authored by:

Family Medicine Physician

This article was co-authored by Chris M. Matsko, MD. Dr. Chris M. Matsko is a retired physician based in Pittsburgh, Pennsylvania. With over 25 years of medical research experience, Dr. Matsko was awarded the Pittsburgh Cornell University Leadership Award for Excellence. He holds a BS in Nutritional Science from Cornell University and an MD from the Temple University School of Medicine in 2007. Dr. Matsko earned a Research Writing Certification from the American Medical Writers Association (AMWA) in 2016 and a Medical Writing & Editing Certification from the University of Chicago in 2017. This article has been viewed 107,382 times.

Co-authors: 16

Updated: September 15, 2021

Views: 107,382

Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

Article SummaryX

If you think you might have gangrene, call your doctor immediately or go to an emergency room. To recognize dry gangrene, look for dry and shriveled skin that is bluish or black, cold to the touch, and numb. You may also feel some pain. Always seek emergency care for wet gangrene, which comes with swelling and pain in the infected area, blackened skin, sores with bad-smelling discharge, and a fever. You might also notice a crackling sound if you press on the area. You should also go to the emergency room if you have severe symptoms such as a rapid heartbeat, difficulty breathing, light-headedness, a sudden fever or chills, or a rash. For advice from our Medical co-author on how to get medical treatments for gangrene, such as antibiotics or surgery, keep reading.

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Gangrene – Causes, Symptoms, Treatment, Diagnosis

The Facts

Gangrene is the death of tissue in your body. It develops when the blood supply to an affected body part is cut off because of various factors such as infection, vascular disease, or trauma. Gangrene can involve any body part, but the most commonly affected areas are the extremities (feet, arms, legs, hands).

Causes

Gas (“wet”) gangrene is the most life-threatening form of gangrene. It occurs in wounds that are infected by a family of bacteria called Clostridium. At least 20 kinds of Clostridium can cause gas gangrene. What makes the clostridia special is that they are anaerobic – that is, they grow best in the absence of oxygen. Because healthy human tissue is full of oxygen, it’s rarely bothered by these bacteria. However, when they do grow, clostridia release gas and poisons into the body. This form of gangrene spreads very quickly, and can cause a rapid death.

Injuries that leave a portion of muscle tissue deprived of oxygen make an ideal home for clostridia. Some of the cells in a wound are already dead, and the infection starts in these. “Crush” injuries are most likely to cut off blood supply to a large amount of tissue, and are most prone to gangrene. The infection usually strikes the extremities, where blood supply is most easily cut off. Car accidents, for instance, often cause crush injuries to the lower legs – exactly the sort of wound that clostridia find most suitable.

Surgery can also produce areas of vulnerable tissue. Conditions favourable to clostridia are most common in people who have preexisting vascular problems, or who have many of the risk factors for heart disease. For example, high cholesterol can make blood more likely to clot. A person with high cholesterol is more likely to have more clotted blood vessels after surgery. The tissue that’s normally fed by those blood vessels can run out of oxygen, allowing bacteria to multiply.

There are other causes of “wet” gangrene that aren’t associated specifically with clostridia. Other bacteria such as E.coli, Klebsiella, and Proteus may cause infected “wet” gangrene in damaged tissue, resulting in a serious, often life-threatening infection.

In contrast, “dry” gangrene occurs when the blood supply to tissue is cut off but no infection develops. In these cases the tissue dies but the person generally feels well overall. Serious diseases that interfere with blood flow can cut off oxygen supply to the extremities, even when there’s no trauma or injury. For example, peripheral vascular disease in which blood flow to the legs is poor can deprive a foot or leg of blood or oxygen, resulting in gangrene. People with diabetes, for instance, are prone to gangrene in the foot. Diabetes-related gangrene is the most common reason for foot amputation. Severe frostbite (due to overexposure to the cold) can also lead to gangrene due to lack of proper blood flow to the tissues.

Symptoms and Complications

Areas affected by infected or “wet” 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 extensively scarred and require reconstructive surgery. If there is a significant amount of tissue death, the affected body part may even need to be removed.

Sometimes, a brown fluid forms under the skin, causing large skin bubbles to rise. If clostridia are the cause of the gangrene, the gas produced by the bacteria can be seen bubbling in these pockets. It often smells foul.

The substances produced by the bacteria are highly toxic to human tissue and kill cells ahead of the infection, keeping the oxygen supply low. Unless the infection is stopped, these bacterial toxins soon reach the bloodstream and begin to poison the vital organs (called toxic shock), with the kidneys failing first.

Making the Diagnosis

Gas gangrene involves a type of necrotizing (flesh-destroying) bacterial infection that a doctor can recognize. A doctor will take a tissue sample or perhaps some fluid from a skin bubble. The sample is grown in a laboratory culture to identify the bacteria. Treatment won’t wait for the results to come back, however. A doctor will start giving a “broad-spectrum” antibiotic immediately.
If the infection is serious, sometimes X-rays or MRI scans are used to locate gas deep under the skin. If surgery is needed, these scans tell the doctor exactly where the bacteria are, and what needs to be removed.

Treatment and Prevention

Gangrene often spreads so quickly that it can’t be stopped by antibiotics alone. Treatment consists of a three-pronged approach:

• Antibiotics help slow the infection and clear small, unnoticed pockets of bacteria.
• A surgeon debrides (cuts away) the infected flesh and a margin around it to prevent further spread. If debridement isn’t enough, amputation is the next step.
• The patient is put in a hyperbaric chamber if one is available. This is a sealed metal tank pumped full of oxygen under high pressure. The pressure forces oxygen into the tissues, stopping the spread of anaerobic bacteria. Hyperbaric chambers were invented to help sea divers with the bends, but they have many uses in medicine.

Antibiotics and surgery are commonly used as the principle treatments for gangrene and have been proven to be very effective. Hyperbaric chambers aren’t widely used because many hospitals don’t have access to them.

With modern treatment methods, the majority of gangrene victims survive, though most lose some muscle tissue. People can reduce their chances of suffering these complications by cleaning all wounds thoroughly with antiseptic, watching for signs of pus, redness, swelling, or unusual pain, and seeing a doctor about any wound that might be infected.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Gangrene

Gangrene – StatPearls – NCBI Bookshelf

Continuing Education Activity

Gangrene is tissue damage secondary to infection, ischemia, or both. It is a relatively uncommon condition, and early recognition is essential. Gangrene is associated with a high incidence of mortality, and in patients that survive, it can have a massive impact on the quality of life. This activity reviews the identification, evaluation, and treatment of gangrene, highlighting the role of the interprofessional team in managing patients with this condition.

Objectives:

• Identify the etiology for the development of gangrene.

• Describe the appropriate assessment for a patient with gangrene.

• Explain the management strategies of gangrene.

• Review the importance of an interprofessional approach to the evaluation and treatment for patients with gangrene.

Access free multiple choice questions on this topic.

Introduction

Gangrene is a clinical condition of ischemic and necrotic tissue, often circumferential around a digit or extremity. It is identified by discolored or black tissue and associated sloughing of natural tissue planes. The three main types of gangrene are wet gangrene, dry gangrene, and gas gangrene.

Dry gangrene is dehydrated ischemic tissue caused by progressive ischemia distal to arterial occlusion, often a progression of peripheral artery disease. Wet gangrene, which may be dry, complicated by a secondary infection, has associated edema and erythema but no crepitus. Gas gangrene is a specific type of necrotizing infection with edema, crepitus, and gas on radiographs. Necrotizing soft tissue infections overlap with the infectious causes of gangrene and involve necrotic skin lesions that may extend into subcutaneous, fascial, and muscle compartments.[1][2]

The associated tissue loss in gangrene can significantly decrease life quality due to associated pain, limited mobility, and increased risk of hospitalization. These conditions can also progress to substantial morbidity and mortality, with the risk of multiple surgeries and death with the disease progression.[3]

Etiology

Dry/ischemic gangrene is most commonly secondary to atherosclerosis and progressive occlusion of the peripheral arterial blood supply to distal tissue. The risk factors of peripheral atherosclerosis overlap with the risk factors for coronary artery disease: diabetes, smoking, hypertension, and hyperlipidemia. Conditions that increase blood demand, such as localized infection and trauma, may worsen limb ischemia.[4] Dry gangrene is often aseptic as bacteria fail to survive in the dry and mummified tissue.[5]

Less common causes of ischemic gangrene are vascular occlusions from other pathology. Thromboembolic disease may rarely result in the cessation of arterial flow if thrombosis is transferred downstream, and arterial thromboses may develop in situ in a hypercoagulable state. Trauma to the limb or vascular system may result in ischemia and gangrene. Vasculitis, adventitial cystic disease, popliteal entrapment, and Buerger disease may also contribute to gangrene development.[4][6] These conditions may also result in acute limb ischemia, which can progress to gangrene if severe. Acute limb ischemia is defined by a sudden decrease in limb perfusion, diagnosed within two weeks of symptom onset. The symptoms of acute limb ischemia are classically identified by the 6 Ps mnemonic: paresthesia, pain, pallor, pulselessness, poikilothermia (disorder temperature regulation), and paralysis.[7]

Ischemic limb gangrene may also occur in limbs with intact peripheral pulses due to thromboses in the microcirculation. Venous limb gangrene is one possible cause where micro thrombosis happens in the same limb as an acute large-vein thrombosis, typically in a hypercoagulable state. Symmetric peripheral gangrene is another condition where multiple limbs may develop symmetric gangrene despite adequate perfusion; an example is purpura fulminans in patients with septicemia secondary to Neisseria meningitidis.[7]

Wet gangrene occurs when tissue compromised by poor venous or arterial blood flow becomes infected. This is most commonly seen in areas prone to edema (lower extremities/feet), though it also can be seen in genitourinary and oral tissues. Diabetic patients are more susceptible to these infections due to poor wound healing and hyperglycemia.[5]

Gas gangrene is historically caused by infection with Clostridium perfringens and other Clostridium species (C.septidum), resulting in clostridial myonecrosis. This organism can cause rapid development of localized tissue necrosis and systemic signs of illness in part due to its production of exotoxins and is characterized by the presence of gas in subcutaneous tissue. Additional bacterial infections may also result in gas production and the rapid spread of infection, including Escherichia coli, Bacteroides, Staphylococcus epidermidis, and streptococcal infections.[8] Type I necrotizing fasciitis, characterized by friable superficial fascia, dishwater-gray exudate, and an absence of pus, is another bacterial infection caused by a polymicrobial mix of aerobic and anaerobic organisms that may also cause gas in tissue.[9]

Epidemiology

Ischemic/dry gangrene occurs as tissue loss most commonly seen with progressive peripheral artery disease (PAD). Critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI) is the most advanced stage of peripheral artery disease, with an incidence of 1% of the United States population over 50 years old and up to twice that over 70 years old.[4] Lower extremity peripheral artery disease itself affects more than 200 million people worldwide, and up to 10% of people with PAD have CLI/CLTI. Over five years, between 5-10% of patients with asymptomatic PAD or minimal symptoms with intermittent claudication, may progress to CLI/CLTI.[6]

Gas gangrene typically occurs after trauma, with anaerobic bacteria’s introduction into a previously protected tissue space. Gas gangrene has been identified after traffic accidents, crush injuries, gunshot wounds, and postoperative complications related to infection. Non-traumatic gas gangrene has also been documented from hematogenous spread, and multiple case studies have demonstrated an association with a metastatic gut malignancy.[10] Similarly, other necrotizing soft tissue infections typically have a defined entry point due to trauma or postoperative surgical site complications.[9] Gas gangrene is relatively rare, with approximately 1000 cases per year in the United States; 50% are attributed to traumatic injuries, 30% to postoperative complications, and 20% as a spontaneous infection.[11]

Pathophysiology

In ischemic gangrene, reduced arterial perfusion leads to arteriole dilation as compensation, resulting in distal edema and endothelial damage. This can trigger a cycle of micro thrombosis resulting in worsening tissue damage. Due to the ischemic environment, localized cellular dysregulation limits the ability to have adequate wound healing and set the tissue up for continued damage and infection.[6]

In gas gangrene, bacteria such as C.perfringens and group A streptococcus can produce multiple exotoxins, resulting in local tissue destruction and subsequent systemic infection.[10] Alpha-toxin, a C-lecithinase, can result in extensive tissue necrosis and promote systemic hemolysis.[11]

History and Physical

Patients with critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI) at risk for developing gangrene will present with limb pain that has progressed from intermittent claudication with exertion to chronic rest pain. The pain may be worsened in an elevated leg and improved in the dependent position due to compromised blood flow. If a concurrent neuropathy is present (most commonly from diabetes), then there may not be a consistent history of pain, and tissue loss may be the first presentation of ischemia.[4]

On physical exam, patients with ischemic gangrene will have rubor of the affected extremity when dependent, and early pallor with elevation. Capillary refill will be reduced, and there may be a loss of overlying hair. Ankle pulses are frequently absent. The location of tissue loss may help identify the cause; ischemic tissue loss typically involves the toes and distal foot; venous ulcerations often overlie the malleoli; neuropathic ulcerations usually start on areas of pressure along with the sole.[4][6] A complete exam of the affected extremity should include identification of any neuropathy and a probe-to-bone test in the setting of any ulceration or tissue loss to identify the depth of tissue injury and risk of osteomyelitis.[12]

Wet gangrene should be suspected if there is associated drainage and edema in the setting of a patient with a previous foot ulcer or tissue injury secondary to diabetes or ischemia. Additionally, plantar tenderness increases the concern for a possible deep foot abscess and should be evaluated thoroughly.[3]

Severe acute limb ischemia will present with significant lower extremity pain, sensory loss (ranging from mild at the toes to permanent diffuse nerve damage), and paralysis of the affected limb. The arterial flow will be inaudible initially, followed by inaudible venous flow as the disease process progresses.[7] 

Gas gangrene presents with pain, edema, the development of hemorrhagic bullae, and color changes ranging from a pale coloration to a bronze-purplish red coloration. The patient often has an associated history of trauma or recent surgical intervention.[5] Necrotizing soft tissue infections, particularly those caused by Streptococcus pyogenes (group A streptococcus), may start as an erythematous initial lesion and progress to a dusky skin coloration with overlying hemorrhagic bullae within 24 to 72 hours of injury. Once the skin becomes gangrenous and starts sloughing, there is a high mortality risk. Patients with necrotizing infections of any type often present with edema, fever, malaise, and pain out of proportion to exam findings – this subtle presentation increases the risk of delayed diagnosis, and high clinical suspicion is essential.[9]

Evaluation

The laboratory evaluation of ischemic gangrene is focused on identifying clinical risk factors such as renal failure, hyperlipidemia, and diabetes, which would impact the treatment plan. Assessments for concurrent infection are also appropriate, though wound cultures are less helpful without additional signs of infection such as localized erythema and swelling.[4][12]

Other tests recommended for ischemic gangrene are focused on identifying the arterial disease’s level and complexity, which will help narrow down treatment options. Non-invasive testing like an ankle-brachial index (ABI) is essential for early identification of PAD in a patient with tissue loss and is considered abnormal if less than 1.0. Ankle pressure below 40-60 mmHg is also consistent with critical ischemia, and in the presence of tissue loss, <70 mmHg is considered abnormal.[13][4] If the ABI is consistent with arterial disease, then additional imaging is used to localize the lesion(s) – Duplex ultrasound, digital subtraction angiography, CT angiography, and MRA are all options.[4] If the ABI is not conclusive, which is common in diabetic patients and those with advanced age as vessel compressibility may be affected, additional non-invasive testing can include ankle pressures, toe pressures, and transcutaneous oxygen pressures.[6]

Multiple classification systems exist for the staging of critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI). The recently developed WIfI (wound, ischemia, foot Infection) system by the Society of Vascular Surgery uses a combination of wound classification, ischemia severity, and the presence of foot infections to provide prognostic guidance regarding treatment recommendations and the anticipated response to revascularization.[4] The specific wound portion of the WIfI classification is rated between 0-3, with 1 being minor tissue loss that may be salvageable with simple amputation, 2 is often gangrene limited to digits (and therefore treatable with multiple digital amputations or transmetatarsal amputation), 3 is the most severe with extensive tissue loss, requiring amputation proximal to the transmetatarsal level for treatment. Using the classifications of WIfI, patients with chronic limb ischemia can be clinically staged by the risk of amputation. They can be classified based on the anticipated benefit of revascularization as well.[13]

If gas or wet gangrene is suspected, Gram stain and wound cultures can help identify the bacterial cause to guide antibiotic therapy, but the diagnosis is typically made clinically. Surface wound swabs are rarely helpful due to potential contamination of skin bacteria, and the sample should be obtained from deep swabbing or aspiration of purulent discharge.[14]

Additionally, X-rays may be able to identify subcutaneous gas, which is always pathologic, and found with gas gangrene and type I necrotizing skin infections.[5][9] CT, with contrast demonstrating a lack of fascial enhancement, and MRI with abnormal signal intensity in the deep fascia, can also help establish the diagnosis. However, surgical intervention should not be delayed if there is clinical suspicion. If the diagnosis is unclear, patients can be evaluated by local exploration under bedside local anesthesia; the return of ‘dishwater’ fluid and easy dissection of fascial planes is characteristic of necrotizing infections and can be followed up by definitive surgical treatment.[15]

Treatment / Management

Treatment of ischemic gangrene is focused on restoring blood flow to help reduce rest pain and heal ischemic wounds. Once ulcers have progressed to dry gangrene, it is unlikely that the tissue will recover completely, but tissue loss can be minimized by medical and surgical management.[4][5] Medical treatment of ischemic gangrene includes the use of antiplatelet therapy with aspirin or clopidogrel and treatment of hypertension with beta-blockers and angiotensin-converting enzyme inhibitors. Hyperlipidemia should be treated with a statin as appropriate, and patients with diabetes should achieve adequate glucose control, ideally to a hemoglobin A1C less than 7%. Smoking cessation is vital for reducing the risk of disease progression.[4][6][5][12]

Surgical treatment of limb ischemia is focused on revascularization to improve pain and prevent limb loss. In the setting of acute ischemia, catheter-based intravascular thrombolysis can be used. Otherwise, revascularization can be pursued with endovascular intervention with balloon angioplasty (with or without stent), and surgical therapy can bypass a stenotic area or directly remove a blockage. The decision to pursue bypass or endovascular treatment is dependent on the lesion and the patient’s comorbidities, and early involvement in a multi-disciplinary vascular team, if available, is recommended.[4][6]

Primary amputation (amputation before an attempt at revascularization) is recommended if there is significant necrosis of the weight-bearing portion of the foot, refractory pain, sepsis/uncontrolled infection, paresis of the extremity, or limited life expectancy.[4][12] Often, above-ankle amputation is recommended if there is extensive foot necrosis.[6][3] Autoamputation is also a possibility, the spontaneous separation of the unviable tissue from the viable tissue; however, a case series of patients with diabetes-related dry gangrene found that only 1 of 12 developed autoamputation – all others required surgical amputation.[2] If more than two digital ray amputations are required to treat necrosis, it is recommended to consider transmetatarsal amputation of the forefoot instead to preserve function – multiple toe amputations can adversely affect pressure distributions and result in worsening pressure injuries.[12]

Treatment with hyperbaric oxygen therapy has been proposed as a method to increase oxygen tension in ischemic tissue. There has not been a demonstrated benefit with critical limb ischemia (CLI). Other potential experimental treatments include the use of growth factors and stem cell therapy to promote angiogenesis; however, there is a lack of clinical data. This treatment is currently limited to clinical trials.[6]

If an infection is suspected as wet gangrene, either based on systemic signs of infection, localized erythema/drainage, or plantar foot pain, urgent surgical drainage and debridement (possibly with minor amputation) are indicated. Antibiotic treatment should be started for all patients with suspected chronic limb-threatening ischemia (CLTI) and additional deep foot infection or wet gangrene. The appropriate dressing should be used to retain moisture without adding maceration.[12][3] Empiric antibiotic choice should depend on patient risk factors and local susceptibility rates; gram-positive coverage is usually indicated, with broadened coverage in diabetic patients to include potential MRSA or gram-negative coverage.[14]

Gas gangrene, with associated exotoxins, can be very aggressive with a high mortality rate when treatment is delayed. Therefore surgical exploration and debridement are recommended as soon as possible to gauge the extent of infection and obtain specimens for culture/Gram stain. The initial surgical site often will need to be re-evaluated and debrided multiple times. Surgery within 24 hours of admission is associated with increased survival.[9][15] Fasciotomies will also help to decompress fascial compartments and promote blood flow. Gangrene of the trunk cannot be amputated, so aggressive debridement is required.[11]

Antibiotic treatment of gas gangrene and necrotizing soft tissue infections should be tailored to the causative organism as soon as possible; however, in the immediate initial evaluation, broad-spectrum treatment with coverage for gram-positive, gram-negative, and anaerobic bacteria should be used. If group A streptococci or Clostridium are identified, the recommended treatment is penicillin with clindamycin for 10 to 14 days; clindamycin is especially recommended to reduce toxin production monotherapy with clindamycin is not recommended due to increased inducible resistance rates. Patients with necrotizing infections are often systemically ill and should be managed based on sepsis guidelines for fluid resuscitation and treatment of associated organ damage.[9]

Differential Diagnosis

Gangrene is typically fairly unique with visible necrotic tissue. The differential diagnosis of limb pain can include

Other potential causes of local ischemia not listed above are

The differential diagnosis for gas gangrene include:

Prognosis

Within one year of the diagnosis of critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI), up to 40 to 50% of patients with diabetes will have an amputation, and 20 to 25% will die.[4] Additional observational studies observed an amputation rate of 19% at six months and 23% at 12 months in nondiabetic patients with rest pain and ischemic ulcers/gangrene. The most common indication for amputation was an untreatable infection.[13][18] Patients should be followed for at least two years after revascularization procedures to evaluate for any recurrence of CLTI.[12]

Gas gangrene has a significant fatality rate; up to 25% of trauma patients with gas gangrene die, with an increase to 100% if treatment is delayed or inadequate. Poor prognosis is associated with increased age and multiple underlying comorbidities and a location on the trunk.[11]

Complications

While most limb salvage treatment is focused on limiting amputations, especially major amputations (above the ankle, requiring a prosthetic for ambulation), amputation may also be optimal for some patients to allow for participation in rehabilitation with a prosthesis. However, retrospective studies have demonstrated that only 65% of patients with below-the-knee amputation and 29% of above-the-knee amputation amputees were ambulatory at one year.[19] Observational studies of patients two years after below-the-knee amputation demonstrated that 15% had a contralateral amputation, 15% progressed to an above-the-knee amputation, and 30% were dead.[17]

Consultations

All patients with suspected critical limb ischemia/chronic limb-threatening ischemia (CLI/CLTI) should be referred to a vascular specialist for consideration of limb salvage unless major amputation is urgently needed.[12]

Necrotizing soft tissue infections with wide or disfiguring debridements should engage multidisciplinary surgical teams as soon as possible; orthopedics, plastic surgery, urology, and colorectal diversion may be needed depending on the location and depth of the surgery.[15]

Deterrence and Patient Education

Patients should be educated on the proper foot and wound protection to promote healing and prevent a recurrence. This includes education on appropriate shoes and insoles, as well as early identification of signs of inflammation.[12] Patients should get medical attention immediately if they develop any symptoms of tenderness, redness, disproportionate pain, or fever. Educate intravenous drug users about potential fatal complications of gas gangrene due to the injection of contaminated heroin or other chemicals.[20]

Enhancing Healthcare Team Outcomes

The early identification of ischemic tissue, whether secondary to infection or peripheral vascular disease, is essential to the success of the treatment strategies listed above. A detailed history and physical, including ankle-brachial index in patients at risk for peripheral artery disease, can identify patients at risk before tissue loss develops.[17] (level of evidence 4) Once ischemia is detected, the use of validated classification scores can provide consistent communication across multiple treatment teams and the patient regarding the risk of amputation and the likelihood of improvement with revascularization.[13] [Level 2]

For necrotizing soft tissue infections and gas gangrene, worsening mortality has been identified with the delay in surgical treatment more than 24 hours after admission, so the entire clinical team is essential in considering the diagnosis and pursuing evaluation and treatment once identified to reduce patient mortality risk.[11] [Level 3]

Figure

Gas gangrene of the right leg and pelvis, showing swelling and discoloration of the right thigh, bullae, and palpable crepitus. The patient, in shock at the time this photograph was taken, underwent a hemipelvectomy and died less than eight hours later. (more…)

Figure

Gas gangrene of a diabetic foot. Contributed by Heather Murphy-Lavoie

Figure

Peripheral Arterial Disease
Non-healing necrotic ulceration and gangrene of the 3rd digit secondary to PAD. Contributed by Mark A. Dreyer, DPM, FACFAS

References

1.

Bahebeck J, Sobgui E, Loic F, Fonfoe L, Nonga BN, Mbanya JC, Sosso M. Limb-threatening and life-threatening diabetic extremities: clinical patterns and outcomes in 56 patients. J Foot Ankle Surg. 2010 Jan-Feb;49(1):43-6. [PubMed: 20123286]

2.

Al Wahbi A. Operative versus non-operative treatment in diabetic dry toe gangrene. Diabetes Metab Syndr. 2019 Mar – Apr;13(2):959-963. [PubMed: 31336551]

3.

Farber A. Chronic Limb-Threatening Ischemia. N Engl J Med. 2018 Jul 12;379(2):171-180. [PubMed: 29996085]

4.

Elsayed S, Clavijo LC. Critical limb ischemia. Cardiol Clin. 2015 Feb;33(1):37-47. [PubMed: 25439329]

5.

Al Wahbi A. Autoamputation of diabetic toe with dry gangrene: a myth or a fact? Diabetes Metab Syndr Obes. 2018;11:255-264. [PMC free article: PMC5987754] [PubMed: 29910628]

6.

Farber A, Eberhardt RT. The Current State of Critical Limb Ischemia: A Systematic Review. JAMA Surg. 2016 Nov 01;151(11):1070-1077. [PubMed: 27551978]

7.

Creager MA, Kaufman JA, Conte MS. Clinical practice. Acute limb ischemia. N Engl J Med. 2012 Jun 07;366(23):2198-206. [PubMed: 22670905]

8.

Brucato MP, Patel K, Mgbako O. Diagnosis of gas gangrene: does a discrepancy exist between the published data and practice. J Foot Ankle Surg. 2014 Mar-Apr;53(2):137-40. [PubMed: 24345706]

9.

Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017 Dec 07;377(23):2253-2265. [PubMed: 29211672]

10.

Lehner PJ, Powell H. Gas gangrene. BMJ. 1991 Jul 27;303(6796):240-2. [PMC free article: PMC1670510] [PubMed: 1884064]

11.

Yang Z, Hu J, Qu Y, Sun F, Leng X, Li H, Zhan S. Interventions for treating gas gangrene. Cochrane Database Syst Rev. 2015 Dec 03;(12):CD010577. [PubMed: 26631369]

12.

Conte MS, Bradbury AW, Kolh P, White JV, Dick F, Fitridge R, Mills JL, Ricco JB, Suresh KR, Murad MH., GVG Writing Group. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019 Jun;69(6S):3S-125S.e40. [PMC free article: PMC8365864] [PubMed: 31159978]

13.

Mills JL, Conte MS, Armstrong DG, Pomposelli FB, Schanzer A, Sidawy AN, Andros G., Society for Vascular Surgery Lower Extremity Guidelines Committee. The Society for Vascular Surgery Lower Extremity Threatened Limb Classification System: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg. 2014 Jan;59(1):220-34.e1-2. [PubMed: 24126108]

14.

Singer AJ, Tassiopoulos A, Kirsner RS. Evaluation and Management of Lower-Extremity Ulcers. N Engl J Med. 2017 Oct 19;377(16):1559-1567. [PubMed: 29045216]

15.

Bonne SL, Kadri SS. Evaluation and Management of Necrotizing Soft Tissue Infections. Infect Dis Clin North Am. 2017 Sep;31(3):497-511. [PMC free article: PMC5656282] [PubMed: 28779832]

16.

Warkentin TE. Ischemic Limb Gangrene with Pulses. N Engl J Med. 2015 Aug 13;373(7):642-55. [PubMed: 26267624]

17.

Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, TASC II Working Group. Bell K, Caporusso J, Durand-Zaleski I, Komori K, Lammer J, Liapis C, Novo S, Razavi M, Robbs J, Schaper N, Shigematsu H, Sapoval M, White C, White J, Clement D, Creager M, Jaff M, Mohler E, Rutherford RB, Sheehan P, Sillesen H, Rosenfield K. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75. [PubMed: 17140820]

18.

Schreuder SM, Hendrix YMGA, Reekers JA, Bipat S. Predictive Parameters for Clinical Outcome in Patients with Critical Limb Ischemia Who Underwent Percutaneous Transluminal Angioplasty (PTA): A Systematic Review. Cardiovasc Intervent Radiol. 2018 Jan;41(1):1-20. [PMC free article: PMC5735197] [PubMed: 28924874]

19.

Landry GJ. Functional outcome of critical limb ischemia. J Vasc Surg. 2007 Jun;45 Suppl A:A141-8. [PubMed: 17544035]

20.

Determann C, Walker CA. Clostridium perfringens gas gangrene at a wrist intravenous line insertion. BMJ Case Rep. 2013 Oct 09;2013 [PMC free article: PMC3822093] [PubMed: 24108766]

90,000 Gangrene – treatment without amputation

Dry gangrene of the lower extremities is the necrosis of a part of the leg due to a lack of blood circulation, in the absence of purulent fusion of tissues. Dead tissues with dry gangrene are mummified – dried, black, clearly separated from living tissues. Most often, dry gangrene of the leg develops after minor injuries and abrasions, with careless cutting of nails in patients with obliterating atherosclerosis or endarteritis.

The photo shows gangrene of the heel area before and after treatment at the Innovative Vascular Center.In most vascular departments, this patient would definitely be offered amputation. We were able to restore blood circulation and restore the foot by grafting a flap onto a necrotic wound.

Necrosis is local in nature and rarely leads to general intoxication of the body, however, with an unfavorable course, it can turn into wet gangrene and lead to general blood poisoning (sepsis) and death of the patient. Timely restoration of blood flow in dry gangrene allows you to limit yourself to the loss of only the dead part of the leg (toe, foot) and maintain support function and walking.

Wet gangrene requires maximum urgency of the intervention, since the process of tissue melting occurs very quickly and can kill the patient in a short time. The photo shows what the gangrene of the foot looks like. Medicine does not stand still and gangrene has learned to heal, and not just cut off. More on this in our article.

Real gangrene treatment at the Innovative Vascular Center

If you or your loved ones are really in danger of gangrene and amputation, then you have come to the right page.Our clinic is an effective medical institution where legs are saved from amputation. We strive to preserve the leg to the last possible, using modern technology and a scientific approach. More than 650 patients with gangrene of the lower extremities are operated on at the Vascular Surgery Clinic annually. Good treatment results are achieved thanks to:

• Dissolving and removing blood clots in vessels.
• Microsurgical operations on the arteries of the leg and foot.
• Angioplasty and arterial stenting.
• Transplantation of skin grafts to replace dead tissue.

The key to successful gangrene treatment at the Innovative Vascular Center is the rational approach of our specialists, microsurgical bypass technologies, the use of the latest developments in endovascular and vascular surgery, and the narrow specialization of our department in the treatment of critical ischemia. A very important condition for the success of treatment is the possibility of restorative plastic surgery on tissues affected by gangrene.

In the photo, at work under a microscope, a vascular surgeon, organizer and head of the extremity rescue clinic Igor Mikhailovich Kalitko. Other vascular surgeons who have mastered the technique of distal vascular reconstructions (Nikolai Aleksandrovich Naumov, Dmitry Vasilyevich Korchagin) mastered them while working under his supervision.

Simple restoration of blood flow does not allow counting on the rapid closure of tissue defects in the foot and lower leg. In some cases, the process of necrosis affects bone and tendon structures and self-healing is impossible.In such cases, our specialists are assisted by the methods of plastic microsurgery. The clinic has introduced technologies for transplanting free tissue flaps on a vascular pedicle. That is, we take the skin or muscle on the supply vessel from the area of ​​the body where there is a lot of skin, fatty tissue and soft tissues, and after that we transplant this complex of tissues to the site of a large defect, achieving healing of postnecrotic wounds in most patients.

Causes of gangrene of the lower extremities

A disease such as gangrene develops due to a lack of blood supply to tissues (ischemia).Blood plays a very important role in our body. It not only carries oxygen and nutrients throughout the body to feed cells, but it also fights infection with antibodies. When the blood cannot reach any part of the body, the cells in it die from hunger and lack of oxygen, and an infection can join. It is this condition that is called gangrene. Depending on the pathological process, the associated infection and the state of dead tissue, two types of gangrene are distinguished: dry and wet.

A separate disease not related to blood circulation is gas gangrene, which develops during infection with anaerobic bacteria and is treated only by amputation and is not related to vascular surgery. With ischemic gangrene, blood does not enter the tissues due to blockage of blood vessels in various diseases. The most common causes of gangrene of the lower extremities are:

• Diabetes mellitus
• Atherosclerosis
• Endarteritis
• Aneurysm
• Cardiac arrhythmias
• Vascular injury
• Obesity
• Raynaud’s disease (a condition where the blood vessels that supply blood to the skin periodically narrow)

Course of gangrene

After it is possible to determine the causes of gangrene, the question of its treatment arises.Without restoring normal circulation, all patients with dry gangrene are amputated sooner or later. The sensations of pain in the leg are so intense that many patients themselves ask for it. The general condition of patients and their ability to undergo surgery without amputation at the initial stage remains good, dry gangrene rarely poses an immediate threat to the patient’s life.

Sometimes surgeons perform the following appointment to convince the patient to agree to amputation.The patient is anesthetized with injectable drugs, then these drugs are canceled and the patient, tormented, agrees to amputation. For most Russian surgeons, signs of leg gangrene are an absolute indication for urgent high amputation.

Very rarely there are cases of rejection of dead tissue – self-amputation, then a pathological stump may form in the patient, which has to be redone for prosthetics. The development of a wet form from a dry one is relatively rare and most often in patients with diabetes mellitus.

After successful vascular surgery and restoration of normal blood circulation, a clear delineation of the gangrene boundaries is observed. The surgeon removes only clearly dead areas of the toes or part of the foot. The wounds heal gradually. With a large area of ​​gangrene and exposure of supporting surfaces, skin grafts are performed in our clinic to close wound defects. With the help of microsurgical methods, our surgeons manage to preserve the limb even with extensive gangrene of the foot and lower leg.

Read more here 90,000 symptoms, causes, diagnosis, treatment and prevention

Gangrene disease is known to many. This is a pathology in which necrosis of organs and some parts of the body occurs. The main symptom of the disease is black, blue or brown skin color on the limbs. It is important to note that pathology, in principle, can affect not only any parts of the body, but also any organs of the human body. However, most often the disease manifests itself precisely on the limbs, changing the color of the tissue.The color usually changes due to the iron sulfide that appears in the body as hemoglobin breaks down. It is important to note that gangrene is considered a very serious disease that can be fatal without urgent and effective treatment. In most cases, if there is gangrene, amputation will definitely get rid of the problem. However, this is only with extremely advanced forms of pathology, when conservative treatment does not help a person at all.

In gangrene, tissues die due to blockage of blood and oxygen, which, in principle, must enter the body for normal functioning.If a bacterial infection suddenly gets into a person, then gangrene very quickly spreads throughout the body, weakening it and injuring the skin.

When it comes to what gangrene looks like, it is usually a black, brown, or blue spot that spreads over the foot, arm, or any other part of the body. There are a large number of pathology symptoms that you should immediately pay attention to.

Symptoms and signs of gangrene

There are different gangrene, the symptoms because of this also differ from each other, since everything depends entirely on the form of the disease.There is dry, wet, gas gangrene. Also, doctors note that gangrene of internal organs occurs.

Specialists identify the following signs of gangrene:

• With dry gangrene, the patient suffers from complete dehydration and rapid exhaustion. As a rule, this type of pathology develops rather slowly, in many cases for several years. However, after a while, the feet or toes are already suffering from changes. The first symptom that manifests itself is acute pain, which gets worse at night and is not blocked by conventional medications.After a while, the affected skin areas completely lose their sensitivity, become pale, cold. It should be noted that it is not necessary to calculate the disease by an unpleasant odor, since this symptom is not characteristic;
• in the wet form, such signs of gangrene as the rapid development of the disease, the cessation of blood supply in a certain part of the body, excess body weight, usually the zone that is affected by the pathology, swells, does not show a pulse.Over time, the skin turns green or turns blue, purple. It is a bit like tissue decomposition. Due to wet gangrene, intoxication of the body often occurs, which negatively affects the body, can spread to any areas, which causes gangrene of the toe or gangrene of the leg;
• Gas gangrene can also rapidly affect, the symptoms of which are sharp soreness, blue or gray skin color, pale edges of the affected area. If you press on the skin that is affected by pathology, it will be possible to hear a rotten smell and see gas bubbles, which indicates the type of disease.The person suffers from severe intoxication, which often leads to a state of shock.

There is not only gangrene of the extremities, but also of the internal organs. Usually in this case, the abdominal cavity suffers. Symptoms include high fever, nausea, pain, fever, rapid heart rate, and low blood pressure.

Do you have symptoms of gangrene?

Only a doctor can accurately diagnose the disease.
Do not postpone the consultation – call by phone

+7 (495) 775-73-60

Causes of gangrene

In order to understand how to treat gangrene, you need to understand the cause of its occurrence and development.Talking about how gangrene begins, experts identify the following reasons:

• bedsores;
• injury to the body by electric shock, acid, alkali, low or high temperature;
• infection with Escherichia coli, Proteus;
• violation of blood circulation.

The cause of gangrene is also of a different nature. For example, gangrene can occur due to impaired metabolism, anemia, deficiency of vitamins, minerals and trace elements, acute diseases.

Risk factors for disease

Pregnancy, childbirth, age 45+, surgery, allergies, smoking tobacco, even wearing small narrow rings or shoes that are not in size can provoke the appearance of the causative agent of gangrene. Gangrene appears quite often in diabetes mellitus. It is important to note that gangrene in diabetes worsens overall health and accelerates the negative effects of diabetes on the body.

Complications

Causes gangrene of the foot, complications such as the secondary appearance of infection in the human body, anemia, the development of kidney failure, intestinal obstruction and other conditions that threaten human life and in most cases lead to death.Gangrene of the lower extremities brings the greatest harm to a person.

When to see a doctor

Self-medication can be harmful to human health, as well as postponing a visit to a specialist, especially if it is gangrene of the extremities.

A surgeon is involved in the treatment of gangrene. It is recommended to consult a doctor after the onset of 2 or 3 symptoms. In no case should you pull until the area of ​​skin turns blue, green, brown or black, as this is most likely already a severe form.If this is the initial stage of gangrene, then simple medical treatment will be enough to correct the situation. A severely affected dark numb limb is already a clear sign of a serious problem. There is no need to aggravate the condition, endure pain at night, feel tired and wait until the whole body is affected, and not just its outer part. Now medicine offers effective treatment for gangrene, which in the initial stages helps almost 100%.

Preparing to visit a doctor

There are no general rules or actions to be taken before going to a specialist.The only thing that can be distinguished is proper nutrition a few days before the diagnosis, since it necessarily includes a general blood test, which shows the state of the body and the level of its infection. It will be much better if at least the blood sugar is not elevated during donation. So it is recommended to at least keep a minimal eye on the diet before going to a specialist who will do an examination, identify the cause, type and stage of a disease such as gangrene of the lower extremities or gangrene of the hands.

Diagnosis of gangrene

Gangrene of the foot, hand or any other part of the body is diagnosed in a complex manner.

For this, the surgeon uses the following methods:

• collection of material for a general blood test and its check for leukocytes, erythrocytes, hemoglobin, eosinophils;
• conducting a biochemical blood test;
• microscopic examination of material that is separated from the wound;
• ultrasound scanning of blood vessels;
• roentgen.

Treatment

Treatment of gangrene is carried out only in a hospital setting. So, if a person has gangrene of a leg, then he certainly cannot get rid of it at home. For treatment, there are activities of both a general and a local nature. Due to the fact that gangrene of a finger or any other part of the body contributes to tissue death, the main goal is to preserve tissue and prevent its further death.

Doctors insist on bed rest, as well as conservative methods that stimulate blood circulation, improve tissue, and eliminate symptoms.Often, patients are prescribed analgesic drugs, blockades, in rare cases, a blood transfusion is prescribed. If a part of the body can no longer be saved, then doctors prescribe the removal of the affected area or organ and prosthetics.

Home Remedies

As a home treatment, it is possible to use compresses and lotions from the leaves of a golden mustache, white lily oil, a compress from dry clay and onions. However, there is no need to rely only on these funds, because traditional medicine does not treat all diseases, especially serious ones.Someone advises taking rye bread, chewing it, spitting it and applying it to the affected area. But with such self-medication, an effective result cannot be guaranteed, unlike a blockade, which will completely relieve pain.

Myths and dangerous misconceptions in the treatment of gangrene

Many, having opened the Internet and the first site that they come across on a topic of interest, having read an article about self-medication and getting rid of gangrene, believe that a few compresses from a medicinal herb and rubbing some homemade solution into the affected area of ​​the skin will help get rid of the disease and avoid death …In fact, this is not the case, because almost always the patient needs medication or even surgical treatment in order to save the body. It is not enough just to take analgesics to minimize pain and use some kind of ointment in the hope that the dark spots will come off the skin. For a full-fledged effective treatment, an integrated approach and constant participation of a surgeon in the course of treatment are required. This is the only way to really cure the disease, and not just heal it.

Prevention of gangrene

Currently, scientists and doctors have not yet developed a specific prophylaxis of gangrene, which gives one hundred percent results.However, there are several preventive recommendations that can save you from the disease:

• it is necessary to compensate for diabetes mellitus;
• it is recommended to avoid high temperatures;
• if a wound appears on the body, it must be carefully treated to avoid any infection;
• it is worthwhile to treat diseases associated with internal organs in a timely manner;
• doctors advise giving up bad habits;
• is best to strengthen the immune system and balance the diet.

How to make an appointment with a surgeon

You can make an appointment with the doctors of our clinic in a convenient way: by phone +7 (495) 775-73-60, fill out the online form on the website, at the clinic’s administrators at the address: 2nd Tverskoy-Yamskaya lane, 10.

90,000 Gangrene of the lower extremity: causes, methods of treatment

Gangrene is the necrosis of a part of the body. Gangrene can be caused by frostbite, burns, trauma, infection, but most often it occurs when there is insufficient blood supply to the organ (this condition is called ischemia).Most often, blood circulation is impaired in the lower extremities and leads to necrosis of the fingers, foot, or the entire leg. Ischemic gangrene of the upper extremities and internal organs is less common.

There are several types of gangrene:

1. Dry gangrene . This type of gangrene is the least dangerous for the patient. Develops gradually against the background of ischemia. The fabrics are mummified (dried). Sometimes the outcome is self-amputation. The development of infectious processes does not occur.

2. Wet gangrene . This type of tissue necrosis is accompanied by the addition of infection with the rapid multiplication of bacteria, which is accompanied by severe intoxication and can lead to blood poisoning. Wet gangrene requires urgent measures to be taken to eliminate it; in the absence of urgent treatment, it can lead to death.

3. Gas gangrene . It happens rarely, it is a type of wet gangrene, caused by infection with bacteria of the genus Clostridia.Differs in a lightning-fast course, severe intoxication and requires emergency amputation of the affected limb.

Causes of gangrene of the lower limb

1. Obliterating atherosclerosis of the arteries of the lower extremities . The most common cause of ischemia (insufficient blood supply). In this case, the disease develops gradually. At first, pain may appear, leg cramps when walking, then at rest. If the pain in the leg becomes constant and becomes unbearable (you can reduce the pain while sitting by hanging the leg down), the leg becomes cold, pale (when walking, the color can change to bluish-purple due to swelling of the veins), this condition is called critical ischemia and requires urgent treatment.As a rule, at this stage, drug therapy is ineffective and surgical restoration of blood flow is necessary to preserve the leg.

2. Diabetes mellitus with lesions of the feet (diabetic foot syndrome) is also a common cause of gangrene of the lower extremity. In this case, gangrene can be limited, affecting the fingers and parts of the foot, or it can develop as a wet gangrene with the progression of the infectious process and rapid spread.Treatment should be comprehensive and include fighting infection, restoring impaired blood flow, and controlling diabetes-related disorders. In case of delayed treatment, loss of a leg and blood poisoning with serious consequences are possible.

3. Acute ischemia . It develops with thrombosis of the arteries feeding the leg or embolism from the cavities of the heart with atrial fibrillation, cavity of the aortic aneurysms or iliac arteries. It develops suddenly, requires emergency surgery to remove a blood clot.

4. Obliterating endarteritis (Buerger’s disease), Raynaud’s disease . Chronic diseases, characterized by inflammation and narrowing of the arteries of the extremities, gradually progressing throughout life, in the terminal stage can lead to gangrene. There are therapeutic regimens that slow down the pathological process. In severe ischemia, microsurgical methods of restoring blood flow are used.

Methods for the treatment of gangrene of the lower limb

Treatment of gangrene should be comprehensive, using both surgical and conservative methods.Conservative methods are aimed primarily at suppressing the activity of the infection, improving the general condition of the patient, and treating diseases against which gangrene has developed. The goal of surgical treatment is to separate the viable tissue from the dead and remove the latter. In this case, maximum efforts are made to preserve the limb.

The Family Doctor Hospital Center provides therapeutic and surgical treatment for critical ischemia, onset gangrene of the lower extremities, diabetic gangrene, including in cases where the patient was denied the right to save his leg by other medical institutions.If it is impossible to stop gangrene on the foot, and inevitable amputation, everything possible is done to preserve the knee joint, which further facilitates prosthetics and prolongs the patient’s active life.

Surgical treatment

Surgical methods such as:

Do not self-medicate. Contact our specialists who will correctly diagnose and prescribe treatment.

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Treatment of dry gangrene: causes and characteristics of the disease | | Infopro54

As a result, the death of living tissues (necrosis) occurs, leading to serious, sometimes irreparable consequences.Gangrene can develop on any part of the human body, but most often the feet and toes are the affected area.

Affecting the lower extremities, dry gangrene causes a powerful impairment of support functions, blackening and “mummification” of tissues. If the disease is allowed to take its course, it has every chance of turning into wet gangrene, with intoxication and sepsis of the body. Despite the dire forecasts, in the 21st century, the disease is being treated, and very successfully. This is evidenced by the statistics of recovery in the Vascular Innovation Center.The methods aimed at preserving the affected leg can be found in the section of the clinic’s website https://angioclinic.ru/zabolevaniya/suhaya-gangrena-nogi/.

Causes and features of the development of the disease

At first glance, it may seem that the cause of any gangrene lies in the infection of large wounds. In fact, everything is different: gangrene develops in an area that is devoid of a full blood supply. If you deprive a limb of blood, it will begin to die – it will become pale, dry and wrinkled. Then the affected tissues turn black and take on a mummy-like appearance.At the same time, a person experiences severe pain, and it is good if he avoids infection, because infection with microbes leads to a dangerous purulent form.

The main cause of the disease is blockage or injury to adjacent vessels. Atherosclerosis, diabetes mellitus, thrombosis, Raynaud’s disease and other diseases are associated with the disruption of vascular function. This can also include radiation injury, chemical burns, frostbite.

Treatment of gangrene at the Innovative Vascular Center

Previously, the word “gangrene” was synonymous with the word “amputation”, because doctors could not do anything else.With the development of vascular surgery, the situation has changed – any limb can be preserved and even returned to its aesthetic appearance. Treatment at the Innovative Vascular Center has a number of advantages:

• an integrated approach that takes into account therapeutic manipulations;
• restoration of the patency of the affected vessel;
• Installation of stents restoring blood circulation;
• professional treatment of ischemia, trophic ulcers, thrombosis.

Each of the above methods is aimed at recovery without amputation.But in order for the actions to be effective, it is worth contacting the clinic in a timely manner.

Every year the center conducts more than 650 surgical operations, during which modern minimally invasive methods are involved:

• elimination of thrombus formation;
• angioplasty;
• vascular stenting;
• microsurgical operations on vessels;
• transplantation of skin grafts from healthy areas.

Yes, the treatment of dry gangrene is a complicated procedure, all doctors are talking about it.But the methods used by the clinic give excellent results. The innovative vascular center is a modern medical approach combined with technological advances and medical professionalism.

Photo from the site of the Vascular Innovation Center

90,000 It is possible to save a leg in the most advanced stage, or Who is at risk for arterial disease

Most of the patients at the Limb Rescue Center, a new subdivision of the First Clinical Medical Center in Kovrov, are men.

According to the head of the Center, a doctor for X-ray endovascular diagnostics and treatment Dmitry Tyutnev, the stronger sex is mainly susceptible to the risk factor for the development of atherosclerosis of the arteries of the lower extremities. It affects women, as a rule, in the case of diabetes.

Dmitry Anatolyevich told about his patients.

Patient Maria Barsukova with Dr. Tyutnev at the Limb Rescue Center in Kovrov (details at the end *)

The patient prepares to dance at her granddaughter’s wedding

Vera Grigorievna Chernova, 76, from the Ivanovo region, has been suffering from insulin-dependent diabetes mellitus for more than 15 years.This year there has been a sharp deterioration. Even at rest, the pain in the left leg did not go away, on the contrary, it increased. Vera Grigorievna has lost sleep. Meanwhile, trophic ulcers began to appear on the leg. Ultrasound (ultrasound) data showed a sad picture: lack of blood supply through the tibial artery, blockage of the superficial femoral artery with the transition to the popliteal artery. There was one solid plaque with 100% overlap.

Without urgent surgery, there was a high risk of losing the affected leg.

– My granddaughter is getting married soon! I promised her to dance at the wedding! – the pensioner begged.

During the surgical intervention, the specialists of the Limb Rescue Center fully restored the patency of the superficial femoral artery, and a stent was implanted into it. All other affected arteries were also normalized. In areas where there were trophic disorders, there was no blood supply, but there was a hidden purulent pocket, the wound was sanitized.

The pensioner was discharged on the 15th day with full intact function, with a normal temperature, improvement in her diabetes mellitus. The endocrinologist of the First Clinical Medical Center Natalya Yakovleva managed to completely compensate the patient for this formidable disease.

Vera Grigorievna is sure that now she will definitely dance at her granddaughter’s wedding.

Dmitry Tyutnev observes the work of fellow surgeons in the monitor

“We try to keep the support as much as possible”

We asked Dmitry Tyutnev several questions:

– What percentage of patients need limb-saving surgery?

– 80 percent of patients who came to us with diseases of the arteries of the lower extremities of varying degrees of neglect needed an urgent operation, that is, it was about salvation, and not about planned treatment.Most were at moderate to high risk of limb amputation.

– At what stage can a leg be saved?

– Up to gangrene, in super-neglected stages, when the extinction of a limb is already observed. In such a situation, we are fighting for the level of amputation, so that it is as low as possible, we are trying to maintain support. If the patient needs a prosthesis after the operation, then it will be something simple, which has little in common with the selection of classic hip prostheses.

It often happens that a person has half of a leg without skin, continuous necrosis. Even in such a seemingly hopeless case, we restore the blood supply to the lower limb, remove dead tissue. Then we transfer the patient to our colleagues – plastic surgeons who restore the skin, and the person can walk on his own leg again.

It happens that we cannot save the entire foot, we fight for every centimeter, but sometimes it comes to amputation of one or two fingers.However, it is better to lose two toes, but keep the entire leg. A two-finger prosthesis is the simplest thing you can think of, with it the support function is 100 percent effective.

– What you are doing looks like a miracle! What is the limb rescue method based on?

– We are talking about hybrid technology, there are very few of them in the world. We have combined the experience of many generations of different areas of open endovascular and open vascular surgery to save the lower extremities.When we work separately, we cannot perform the full range of manipulations that the patient needs. We have these operations on stream. We are glad that we are working in a team in which there are practically no unsolvable tasks for us. We do not stand still, we are constantly improving our method.

Recorded by Katerina Migulina.

In the photo *: Dmitry Tyutnev with 78-year-old patient Maria Ivanovna Barsukova (surname has been changed). She was sent to the Center for Rescue of Limbs in Kovrov, as recently she practically could not step on her right leg and, accordingly, walk.The problems with the leg were caused by diabetes mellitus, the neuroischemic form of the diabetic foot, dry gangrene of the first toe, and foot ulcers.

How to cure diabetic gangrene on the leg: an old recipe

An old way to avoid leg amputation in diabetes.

Insidious Disease

Diabetes mellitus is one of the most serious diseases of our time.There are several types of disease in which a person not only needs to maintain normal blood sugar levels. With this disease, all kinds of wounds, injuries, which are often poorly treated, are very dangerous. As a result of which gangrene may develop. If you do not start treatment in time, you will not last long until amputation.

Outlet e st always

Even in Russian villages, healers treated diabetic gangrene with aspen ash.In this way, more than one generation got rid of the terrible torment. Nowadays, a log of aspen is not so difficult to find. So try this recipe.

Yes, a small wound can be healed with medication. But this simple recipe will help completely cure.

Needed aspen

To get the magic ash, you need an aspen, or rather, one log. It’ll be enough. Next, find a place where you can burn it. This should be done in a frying pan.New-fashioned kitchen utensils will not work in this case. Take an ancestor-tested cast iron skillet.

Ash can be about 7 full tablespoons with a slight slide. It’s enough. Pour the ashes with boiling water, about 1.5 liters for this amount, and close the lid. As soon as the mixture has cooled to a tolerable temperature, put your foot in it, continuously pouring infusion over the wound until the water cools.

It is not necessary to filter the ash. This is a pure product, which was even used to fill up purulent wounds in the absence of streptocide.The pain will begin to subside after the first procedure.

If not, reheat the same water (no need to boil) and repeat all over again. After the procedure, do not wipe your leg, let it dry out like that.

Secret of procedure

The good thing about this recipe is that while the treatment lasts, you can use the same infusion. You can do the procedure quite often, as soon as you feel pain. After about 8-10 days, the wound heals. If you manage to stock up on a large amount of ash, then you can change the infusion every 2-3 days.It is even better to completely immerse the injured part of the body in the solution and hold it until the water cools.

90,000 Gangrene of the lower extremities, foot and toe – treatment and assistance

Gangrene, or necrosis, is a pathological process in which living tissues die.

External (exogenous) reasons include:

1. injuries,
2. bedsores,
3. physical agents (burns or frostbite),
4. chemicals (acids, alkalis, etc.)NS.).

Internal (endogenous) causes are all pathological processes occurring in the body, which are accompanied by a violation of tissue nutrition.

Symptoms of foot gangrene

It should be noted that the symptoms depend on the form of the disease. In diabetes mellitus, it can be dry and wet.

• Dry gangrene occurs when the patency of blood vessels gradually decreases. This is a long process (sometimes several years), so the body has time to develop defense mechanisms.Typically, dry gangrene affects the toes, which later become desensitized. The general condition of the patient does not change, since there is only a slight absorption of toxins into the blood.
• Wet gangrene has completely different symptoms. If, with a diabetic foot, the wound becomes infected with anaerobic microbes, the infection develops rapidly. The volume of tissues increases, they acquire an unnatural blue-violet and greenish tint. The affected area gives off an unpleasant odor.Severe intoxication leads to a serious deterioration in the patient’s condition.

Treatment and prevention

The only way for wet gangrene is urgent amputation. The dry type in diabetes does not pose such a danger to the patient’s life. However, the treatment of dry leg gangrene involves a whole range of measures to eliminate the cause of the development of necrosis. At the first sign, you need to see a doctor.

Prevention involves careful attention to the condition of the feet.Even a seemingly insignificant injury can develop into gangrene. For this reason, any wounds must be treated with antiseptic agents.

The new generation wound-healing agents have shown high efficiency. Wipes and gels produced by “Lita-Tsvet” have antimicrobial and biostimulating effects. The medicinal composition ensures fast and successful wound healing. Today, these drugs are successfully used by endocrinologists and surgeons in Russia, which is confirmed by the reviews of patients and doctors.

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