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Is gangrene treatable: What Is Gangrene? Types (Fournier’s, Gas, Wet & Dry) & Treatment


Gangrene | Johns Hopkins Medicine

What is gangrene?

Gangrene is a dangerous and potentially fatal condition that happens when the blood flow to a large area of tissue is cut off. This causes the tissue to break down and die. Gangrene often turns the affected skin a greenish-black color. However, the word gangrene is not related to the color green, but to the condition itself. It comes from Greek and Latin words for a gnawing sore or decayed tissue. 

Gangrene comes in 2 forms, dry and wet:

  • Dry gangrene occurs when the blood supply to tissue is cut off. The area becomes dry, shrinks, and turns black. 
  • Wet gangrene occurs if bacteria invade this tissue. This makes the area swell, drain fluid, and smell bad.

What causes gangrene?

Gangrene happens when blood supply to certain tissues is stopped. This can happen due to:

  • An infection
  • An injury such as a burn or combat wound
  • A chronic disease

Chronic diseases that harm the circulatory system include diabetes, peripheral artery disease, and Raynaud’s disease. These can often lead to gangrene. Traumatic injuries like burns or an infected dog bite may also stop blood flow. Severe cases where the skin freezes (frostbite) can also lead to gangrene.

Who is at risk for gangrene?

People with diabetes, peripheral artery disease, and Raynaud’s disease are at higher risk for gangrene. Skin infections, injuries, burns, dog bites, and frostbite also put people at risk for gangrene.

What are the symptoms of gangrene?

Symptoms of gangrene depend on its location and cause. Dry gangrene usually starts with a red line around the affected area. This area then turns dry and black.

These are other symptoms of gangrene:

  • Coldness and numbness in the affected area
  • Pain in or beyond the affected area
  • Redness and swelling around a wound (this is often present when wet gangrene develops)
  • Sores that keep cropping up in the same place
  • Persistent, unexplained fever, with a temperature higher than 100.4°F (38°C)
  • A bad-smelling wound
  • Striking discoloration of the skin, with shades of greenish-black, blue, red, or bronze
  • Pus or discharge from a wound
  • Blisters and a crackling feeling under the skin
  • Confusion, pain, fever, and low blood pressure, especially if the gangrene is internal
  • Shock

The earlier gangrene is treated, the more successful the treatment is likely to be. So if you have any of the above symptoms, seek immediate medical attention.

How is gangrene diagnosed?

If you have symptoms of gangrene, your healthcare team will give you a physical exam to check for signs of tissue death. They may also ask you about any chronic health conditions you have that could be linked to the gangrene.

Your healthcare provider may also want to do lab tests to check for gangrene. A higher than normal amount of white blood cells, for example, can mean you have an infection. Your healthcare provider may take samples of tissue or fluid from the affected area and look at in the lab. If your healthcare provider thinks you may have internal gangrene, he or she may order imaging tests or surgery to find out for sure.

How is gangrene treated?

Your healthcare provider will figure out the best treatment plan for you based on:

  • Your age, overall health, and medical history
  • How sick you are
  • How well you handle certain medicines, treatments, or therapies
  • If your condition is expected to get worse
  • The opinion of the healthcare providers involved in your care
  • Your opinion and preference

Treatment of gangrene will usually consist of 1 or more of these procedures:

  • Antibiotics. These medicines can be used to kill bacteria in the affected area. They are used only when wet gangrene is present
  • Surgery to remove the dead tissue. This is called debridement. It can help keep the gangrene from spreading to healthy tissues nearby. In cases where the gangrene is widespread, a finger, toe, or even a limb may need to be amputated.
  • Maggot debridement. This is a nonsurgical alternative to traditional debridement. During this procedure, clean fly larvae are placed on the affected area to eat away dead tissue and remove bacteria. This is a painless procedure.
  • Hyperbaric oxygen therapy. During this procedure, you are placed in a special pressurized chamber that administers oxygen at high pressures, forcing more oxygen into the affected area. This can promote speed healing and help kill bacteria. This treatment is especially effective in people who develop gangrene from diabetic foot ulcers.
  • Vascular surgery. If your gangrene is caused by poor blood flow, your healthcare provider may recommend surgery to improve your circulation. People whose gangrene is a result of a blocked artery, for example, may have bypass surgery or an angioplasty to fix the problem.

What are the complications of gangrene?

Because gangrene can spread rapidly over a large area of the body, the amount of dead tissue can be quite large. Treating these large areas may result in:

  • Large areas of scarring
  • The need for reconstructive surgery
  • Amputation

Severe cases of gangrene may lead to organ failure and even death.

What can I do to prevent gangrene?

You can help prevent gangrene by carefully watching any wounds you have and getting immediate attention if signs of infection develop. If you have certain conditions that can affect blood circulation (such as diabetes, peripheral vascular disease, Raynaud’s disease), follow your healthcare provider’s instructions on managing your condition very carefully.

When should I call my healthcare provider?

Gangrene is a medical emergency. The outlook with gangrene depends on the location and size of the affected area, as well as any other medical conditions you might have. Gangrene is often life-threatening, so immediate medical care is crucial. 

Key points

  • Gangrene is a dangerous and potentially fatal condition that happens when the blood flow to a large group of tissues is cut off.
  • People with diabetes, peripheral artery disease, and Raynaud’s disease are at higher risk for gangrene.
  • Symptoms of gangrene include coldness, numbness, pain, redness, or swelling in the affected area.
  • Amputation is sometimes needed.
  • Gangrene is a medical emergency.


Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

Successful Treatment of a Severe Case of Fournier’s Gangrene Complicating a Perianal Abscess

A 67-year-old male patient with diabetes mellitus and nephritic syndrome under cortisone treatment was admitted to our hospital with fever and severe perianal pain. Upon physical examination, a perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. A diagnosis of Fournier’s gangrene was made. He was treated with immediate extensive surgical debridement under general anesthesia. The patient received broad-spectrum antibiotics, and repeated extensive debridements were performed until healthy granulation was present in the wound. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh. He was finally discharged on the 57th postoperative day. Fournier’s gangrene is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical emergency. The mainstay of treatment should be open drainage and early aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotics therapy.

1. Introduction

Fournier’s gangrene (FG) is a rare, synergistic, fulminant form of necrotizing fasciitis involving the genital, perineal, and perianal regions [1]. After first description, understanding of this disease has considerably changed and its epidemiology, clinical features, and pathogenesis have been well defined.

Nowadays, FG is defined as a potentially fatal condition, affecting any age and gender, which results in thrombosis of small vessels, obliterative endarteritis, and eventually skin and tissue necrosis [2]. Predisposing factors believed to contribute to the development of the disease are diabetes mellitus, alcoholism, malignancies, immunosuppression, lever, and renal disease [3–5]. In the majority of cases, aerobic and anaerobic bacteria are synergistically involved as a result of anorectal and urogenital trauma and/or infection.

FG is characterized by high mortality rates, ranging from 15% to 50% and is an acute surgical and urological emergency [1]. The keystones of management are hemodynamic stabilization, effective antibiotic treatment, and urgent aggressive surgical debridement.

We present a case of Fournier’s gangrene following a perianal abscess which was successfully treated in our department despite the severity of the patient’s condition.

2. Case Presentation

A 67-year-old male patient was admitted to our hospital with severe perianal pain and high fever (39°C). The patient was obese and had a history of diabetes mellitus under oral hypoglycemics and nephritic syndrome due to glomenulonephritis under cortisone treatment. Upon physical examination, the patient was hypotensive (90/60 mm Hg) and tachycardic (120/min). A perianal abscess was identified. Furthermore, the scrotum was gangrenous with extensive cellulitis of the perineum and left lower abdominal wall. Crepitations between the skin and fascia were palpable. White blood cell count was 10000/μL, C-reactive protein (CRP) was 25 mg/dL, and blood glucose was 300 mg/dL. Computed tomography of the lower abdomen and pelvis revealed extensive emphysema around the testicles, perineal subcutaneous tissue, and around the left internal iliac vessels (Figure 1). A diagnosis of Fournier’s gangrene complicating a perianal abscess was made. The patient underwent aggressive fluid administration and hemodynamic support. He was treated with immediate extensive surgical debridement under general anesthesia (Figures 2(a) and 2(b)). Tissue cultures were obtained for the isolation of the responsible microorganisms. The necrotic skin in the scrotum and the perianal region was evacuated into a wide-open drainage area, without any damage to the testicles spermatic cords, or external sphincter (Figure 3). In addition, a diverting colostomy was performed.

Preoperative antibiotic treatment with broad-spectrum antibiotics combinations was initiated and later adjusted to the culture sensitivity of the microbial isolates. According to tissue samples taken during debridement, the microbiological etiology of Fournier’s gangrene was polymicrobial. Staphylococcus haemolyticus, Citrobacter braakii, and Morganella morganii were detected. Therefore, the patient received metronidazole, penicillin G, ciprofloxacin, and teicoplanin intravenously. Regarding nutrition, he initially received total parenteral nutrition. We continued with enteral nutrition on the 5th postoperative day, and finally he received oral feeding a few days later.

He underwent three subsequent surgical debridements. Due to the fact that his left testicle was severely exposed, it was transpositioned into a subcutaneous pocket in the inner side of the left thigh on the 7th postoperative day (Figure 4). Local wound care was performed with moist gauze dressings (i.e., normal saline) changed twice daily until healthy granulation tissue was observed. Subsequently, dry dressings were used.

The infection gradually subsided, the gas gangrene resolved completely, and good granulation was present four weeks after surgery (Figure 5). The viability of the testicle was confirmed with a Doppler ultrasound on the 50th postoperative day. With regards to the diabetes mellitus, the blood glucose levels remained within normal levels with oral hypoglycemic as the only treatment. The patient was finally discharged on the 57th postoperative day.

3. Discussion

The syndrome of FG is an uncommon but quite serious problem. This entity affects both men and women and at a wide age range, from neonates to the very elderly. Despite this, the mean age of patients appears to range from 40 to 50 years [1]. Our patient was 67 years old, which is in accordance to some recent reports of an increase in the peak age incidence.

Earlier, FG was considered to be an idiopathic entity, but nowadays the most common initial ports of entry are thought to be local trauma or extension of a urinary tract or perianal infection [6]. With regards to the genitourinary tract, urethral strictures and transurethral instrumentation are the most frequent etiologies; other causes include surgery of the penis and scrotum, transrectal prostate biopsy, urethral calculi, bladder cancer infiltrating the urethra, and phlebitis of dorsal penis vein [7–9]. Anorectal sources of infection include ischiorectal, perianal, and intersphincteric abscesses, especially those inadequately treated [8]. Diverticular perforation, carcinoma of the sigmoid colon and rectum [10], perforated acute appendicitis [11], internal hemorrhoids ligated with rubber bands [12], and anal dilatation [13], have also been reported in the etiology of FG. In our patient, a perianal abscess was found to be cause of FG.

The infection arises from bacteria inoculation in the perineal area. This procedure can be facilitated by an impairment in the immune system; diabetes mellitus, alcoholism, malignancies, leukemia, treatment with steroids, AIDS, renal failure, and hemodialysis predispose to the development of FG [3–5]. Diabetes mellitus, in particular, represents an apparent associated factor due to the defective phagocytosis, the increased incidence of urinary tract infections as a result of functional urinary tract obstructions from diabetic neuropathy and disease of the small vessels [5]. In our case, the patient suffered from diabetes mellitus and obesity and was treated with cortisone due to glomerulonephritis.

The most common clinical features are perianal pain and swelling if the anorectal area is the portal of entry, whereas urinary retention, testicular, or scrotal pain are present if the infection launches from the genitourinary tract [8]. Other systemic manifestations such as fever, tachycardia, electrolyte imbalances, and hyperglycemia may also be present. Our patient was admitted to our hospital with severe perianal pain, scrotal edema, crepitus, fever, tachycardia, and low blood pressure.

Once a diagnosis of FG has been established, the central principles of management are aggressive hemodynamic stabilization and parenteral broad-spectrum antibiotics which will be either changed or continued according to the culture findings. In order to ensure a successful outcome, the critical step is urgent and extensive surgical debridement [1, 2, 7]. All frankly necrotic tissue and those with doubtful viability should be carefully debrided and excised.

Colostomy should be done in selected cases where the FG involves the anorectal area and sphincter and for patients in high risk of fecal contamination. We decided to perform a diverting colostomy in our patient, since the gangrene extended to perianal area and fecal contamination would therefore be expected.

Testes and spermatic cords are generally not affected by this disease, because they are supplied by the testicular artery. In some studies, patients underwent orchiectomy when severe infection in the peritesticular tissues was observed intraoperatively [2]. In our case, the left testicle was totally exposed, so it was placed subcutaneously in the inner side of the left thigh. Although, concerns over temperature regulation, future function of the testicles, testicular pain, and atrophy have been expressed [14], none of these problems were encountered in our case. Moreover, the viability of the testicle was confirmed by Doppler ultrasound several days postoperatively.

Although the number of patients with FG has decreased due to medical progress, the mortality is still high. In patients presenting with sepsis, diabetes mellitus, and late admissions to the hospital mortality rates were found to be highest [4]. Hospitalization for this disease is extremely long with a reported average of six weeks [15]. Our patient survived and was discharged 57 days after admission to the hospital, despite the severity of his condition and the negative prognostic factors.

4. Conclusions

Fournier’s gangrene represents a severe condition with a high morbidity and mortality. Therefore, an aggressive multidisciplinary management is mandatory. Fluid resuscitation, antibiotic therapy, nutritional support and, most importantly, repeated surgical debridement remain the cornerstone of the therapeutic approach.


Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Diagnosis and treatment of gangrene

Gangrene is caused by death of tissues due to lack of blood supply. This may be caused by long term diseases that lead to damage to blood vessels like diabetes or due to blood vessel injury like in burns or injuries that give way to deeper tissue infections. These infections cause the part to swell up leading to occlusion of blood vessels.

Diagnosis of gangrene

Diagnosis of gangrene is based on history, physical examination and clinical and laboratory tests.

Medical history may indicate a long term health condition like diabetes, high blood cholesterol, injury in an accident or burn.

Physical examination shows discoloration of the affected area. In case of dry gangrene there is a dried, cool and black appearance of the affected limb.

Wet gangrene on the other hand leads to a swelling of the limb or the affected area. There is evidence of collection of foul smelling pus. (1-5)

Laboratory tests for gangrene

Laboratory tests include;

  • Blood tests – Routine blood tests indicate rise in white blood cells. There may be high blood sugar detected in diabetics.  Sometimes diabetes may present initially as a case of gangrene. In patients with arteriosclerosis there may be high cholesterol.
  • Examination of pus – The pus from the gangrene especially wet gangrene is examined under the microscope. The fluids may be tested for bacteria after staining it with special dyes called Gram stain. Bacteria are stained with a dye and examined under a microscope. The tests are also useful to detect the antibiotics that are potent against the infective organism.
  • Blood culture – Blood culture is performed to check for the actual growth of bacteria present in the blood.
  • Radiographical imaging – Radioimaging studies include X rays, CT scans and MRI scans. These help detect the blockages in the blood vessels.
  • Surgical examination – Surgical examination is needed to confirm a diagnosis of gangrene in any of the internal organs.

Aims of treatment of gangrene

Treatment of gangrene has three important aims (1-5):

  • Surgical debridement of removal of the infected tissues so that the infection does not spread via the blood vessels.
  • The treatment aims at prevention of the infection and its spread.
  • To treat and control the underlying condition that leads to the gangrene to prevent recurrence. A vascular or blood vessel surgery is performed to prevent occlusion and diabetes is controlled to prevent diabetic gangrene.


Antibiotics are used to treat the infection. Oral antibiotic pills and intravenous antibiotics are used. Antibiotics may also be injected into the muscles.

Patients with gas gangrene and infections with Clostridium respond well to antibiotics like:

  • Penicillin
  • Clindamycin
  • Tetracycline
  • Chloramphenicol
  • metronidazole and a number of cephalosporins

Some patients also require fluids and nutrients. Pain relievers are advised to reduce the pain associated with gangrene.

Surgical debridement

Surgical debridement involves removal of dead tissue that results from gangrene. This allows for the healthy surrounding tissue to heal and also prevents spread of infection.

Sometimes when the gangrene is severe, where the whole part like the toe or finger or limb is affected, surgical amputation may be the only option available.

Blood vessel surgery

Blood vessel surgery is of two types – bypass surgeries and angioplasty. Bypass surgeries create a diversion. The diversion redirects the flow of blood to bypass the obstruction.

Sometimes a process called angioplasty may be performed where a balloon like device placed into a blocked, artery and inflated to keep the artery open and patent.

Maggot therapy or Biological therapy

Sometimes a novel therapy called Maggot therapy also known as biological therapy may be applied. There are certain maggots or fly larvae that are used for debridement to feed on dead and infected tissue.

The maggot leaves the healthy tissue unaffected. These maggots also release some substances that kill bacteria they also stimulate healing.

These maggots are specially bred in the laboratory with sterilized eggs. The maggots are put onto the wound and it is covered with a gauze and dressed. The dressing is cut off after a few days and the maggots are removed.

Alternative treatments of gangrene

Hyperbaric oxygen (HBO) therapy is an alternative treatment. Since gangrene is caused by lack of oxygen this may help in healing.

The patient is placed within a special chamber and the chamber is filled with pressurised air and a plastic hood with pure oxygen. The plastic is placed over the gangrenous part. It causes the oxygen to dissolve into the blood and more oxygen can be delivered into the affected area to speed up healing.

HBO therapy prevents further damage by the bacteria and prevents production of toxins by the existing bacteria.

Prevention of gangrene

Prevention of gangrene involves keeping blood sugar and cholesterol under control. Patient is advised a healthy balanced diet, regular exercise and good foot and limb care.

Diabetics should get their feet checked by podiatrists at least once a year for prevention of foot ulcers that may turn into gangrene.

Patient should avoid walking barefoot, avoid harsh chemicals over foot and other extremities, keep feet clean and dry and avoid burns over the foot.

Stopping smoking can cut down risk of gangrene. Smoking leads to blockage of small arteries and loss of blood supply to fingers and toes known as peripheral arterial disease.

Similarly excessive alcohol leads to high cholesterol and arteriosclerosis and blockage of arteries.

Further Reading

Cellulitis Complications and How to Prevent Them

Cellulitis is a common bacterial infection of the deeper layers of skin that is usually treatable with antibiotics. In rare instances, however, it can become life-threatening, particularly if it goes untreated or if complications are not recognized and treated. (1)

“Usually cellulitis develops when a crack or break in the skin allows bacteria to enter into it,” explains Edidiong C. Kaminska, MD, a dermatologist on the faculty of Northwestern University’s Feinberg School of Medicine in Chicago who is also a spokesperson for the American Academy of Dermatology.

It typically affects the dermis — the layer of the skin below the top, outer layer (the epidermis). The dermis contains blood vessels, oil and sweat glands, nerves, hair follicles, and other structures, as well as subcutaneous connective tissue. Occasionally cellulitis spreads to the muscle and bone. (1,2)

What Are the Symptoms of Cellulitis?

“With cellulitis the skin appears swollen and red. It is typically painful and warm to touch,” says Dr. Kaminska. “The most common location for cellulitis is the lower legs, but it can occur on any part of the body, including the face. Additionally, it usually affects one side of the body, so for example, it’s very rare to have cellulitis affect both legs.”

It can also affect the area around the eyes (periorbital or preseptal cellulitis) or behind the eyes (orbital cellulitis), she notes.

Other symptoms of cellulitis can include:

  • A skin sore or rash that appears suddenly and worsens quickly within the first 24 hours
  • A tight, shiny, stretched appearance to the skin
  • Joint stiffness from swelling of the tissue over an affected joint
  • Nausea and vomiting

How Is Cellulitis Treated?

“The first line of treatment for cellulitis usually includes a prescription oral antibiotic,” says Kaminska. “Typically you will see a response within the first three days. You should notice that the redness, swelling, and tenderness are starting to go down. It is important for patients to know they should complete the total prescribed course of antibiotic treatment, even if they feel better.”

Normally, cellulitis will clear up with antibiotic treatment within 7 to 10 days.

What Are the Complications of Cellulitis?

While cellulitis is usually simple to treat, in rare cases, complications can occur. These can include:


“Sometimes the bacteria collect beneath the skin and fill up a pocket with yellow pus, which we call ‘purulent.’ The drainage can be smelly,” says Kaminska.

“If cellulitis is complicated by an abscess, the treatment of course is surgery, which involves an incision and drainage. They cut the skin to release that pocket and drain all of the pus out,” Kaminska says.


Gangrene is dead or dying tissue, and it happens when the blood supply to the tissue is lost. This can happen for a number of reasons, including infection. The affected site may turn black or blue, discharge pus, hurt, or feel numb.

Gangrene caused by or accompanied by infection is a medical emergency, and you should seek help for it immediately.

Treatment may include surgery to remove dead tissue, intravenous antibiotics to treat the infection, and hyperbaric oxygen therapy to increase the amount of oxygen in your blood and slow the growth of bacteria that grows best in the absence of oxygen. In extreme cases of gangrene, an amputation may be required. (3,4)

Necrotizing Fasciitis

“Sometimes the infection can go into the deeper layers of the tissue and it can cause necrotizing fasciitis, which is an extreme emergency,” says Kaminska.

Also known as “flesh-eating disease,” the condition is caused by a rapidly spreading bacterial infection of the fascia (connective tissue) and surrounding soft tissue, causing the tissue to die and possibly leading to the loss of limbs or even death. The treatment is surgical removal of dead tissue and administration of intravenous antibiotics. (5)


In the United States, hospitalizations for cellulitis nearly doubled between 1998 and 2013, to approximately 537,000. The rise in incidents may be partially attributable to a contemporaneous rise in methicillin-resistant Staphylococcus aureus (MRSA) infections, which are resistant to many of the antibiotics used to treat ordinary staph infections. (6,7)

Rachel Bystritsky, MD, a clinical fellow at the University of California in San Francisco department of infectious diseases, says MRSA can be a concern “particularly for cellulitis that involves an abscess or pus or if there are other risk factors like injection drug use.”

If the bacteria causing cellulitis is indeed MRSA, she says, “You would need to use drugs that cover MRSA, such as trimethoprim sulfamethoxazole and clindamycin or doxycycline; or if admitted to the hospital, vancomycin is the main drug that we use.”

Orbital Cellulitis

Orbital cellulitis involves the fat and muscle around the eye, affecting the eyelids, eyebrows, and cheeks.

“It is an emergency,” says Kaminska. “It can limit eye movement, cause bulging of the eye, pain, and loss of vision.”

Discolored eyelids and fever are other symptoms, and left untreated, it can also lead to septicemia (bacteria in the bloodstream, also called bacteremia), cavernous sinus thrombosis (a blood clot in the cavernous sinus, a cavity in the brain), hearing loss, meningitis, and blindness.

In children orbital cellulitis can be caused by a sinus infection caused by Haemophilus influenzae, a type of bacteria that causes a variety of types of infections, most commonly in babies and children. (8)

Orbital cellulitis should not be confused with the less serious condition of periorbital (or preseptal) cellulitis, Kaminska says. That condition involves the skin around the eye and eyelids, and presents as swelling, redness, and discharge from the eye.

“With periorbital cellulitis the treatment is oral antibiotics, but people with orbital cellulitis need IV antibiotics,” says Kaminska. Surgery may also be needed to drain an abscess or relieve pressure around the eye.

Perianal Streptococcal Cellulitis

Usually occurring in children, this form of cellulitis affects the anus and rectum. The infection can be a result of strep throat, the common cold, or streptococcal skin infection (impetigo). Symptoms include fever, pain, itching, redness around the anus, or blood in bowel movements. Treatments include oral antibiotics such as penicillin and topical antibiotics such as mupirocin. (9)

Even in the absence of cellulitis, the perianal skin can be the source for the strep bacteria if a child experiences repeated bouts of strep throat or streptococcal skin infections.


Cellulitis that goes untreated “can go inside of the body, spread to the bloodstream and become life-threatening, though that is very uncommon,” says Kaminska.

Septicemia, or infection of the bloodstream, can lead to sepsis, an extreme inflammatory response to infection. Sepsis in turn can lead to septic shock, in which blood pressure drops and the functioning of major organs shuts down.

The treatment for septicemia typically requires hospitalization and may include IV antibiotics, medication to raise blood pressure, other medications, oxygen, intravenous fluids, kidney dialysis, and possibly being placed on a breathing machine. (10)


Lymphedema, or swelling in an arm or leg because of a blockage in the lymphatic system, can be a risk factor for cellulitis, but it can also be caused by cellulitis. Specifically, recurrent cellulitis can damage your lymph drainage system, leading to chronic swelling of the arms and legs.

Recurrent cellulitis can be treated with a prophylactic (preventive) course of antibiotics to end the cycle of infections. (11)

How Can You Prevent Cellulitis and Its Complications?

Anything you can do to prevent breaks in your skin will reduce your risk of cellulitis and, hence, complications of cellulitis.

Do What You Can to Avoid Injury

Everyone should take common-sense steps to reduce their risk of skin injury, but if you have diabetes, you may have loss of sensation in your limbs, notes Kaminska, so you may not even notice small wounds. People with diabetes should therefore be extra vigilant about checking their feet, hands, legs, and arms for abrasions, cuts, cracked skin, or injuries.

Diabetes may also result in dry, cracked skin, particularly on your feet. (12) This can provide an entry point for bacteria to infect your skin and cause cellulitis. If you have diabetes, make sure you are also going to your podiatrist regularly, Bystritsky advises.

Treat Any Wounds Immediately

Wash minor wounds with soap and water, apply an antibiotic ointment, and cover the area with a bandage that you change daily (or as often as your doctor recommends). Keep bandages and the injured area clean until it heals. (13)

For severe wounds or wounds that aren’t healing normally, see a doctor.

Manage Any Underlying Infections or Diseases That May Have Contributed to Your Cellulitis

Diabetes, cancer, HIV/AIDS, lymphedema, peripheral vascular disease, obesity, and chronic skin conditions such as eczema all raise the risk of developing cellulitis. In the case of recurrent cellulitis, this is especially important to stay on top of, says Bystritsky. “Make sure your skin is in good condition,” she says. “Treat nail fungal infections or fungal infections between the toes.”

Keep Your Skin Clean and Moisturized and Your Nails Well-Manicured

Moisturizing helps keep the skin from cracking and thus providing a way for bacteria to get into the skin. Keeping your nails shorts lessens the likelihood you will scratch yourself.

The website of the American Academy of Dermatology has additional advice for preventing cellulitis.

What does Jardiance do to your perineum?

Jardiance is in a class of newer drugs used to treat type 2 diabetes associated with a rare, life-threatening genital area infection called necrotizing fasciitis of the perineum (Fournier’s gangrene). The infection is caused by bacteria entering the layer of tissue just under the skin in the perineum, the space between the anus and scrotum in men and the anus and vulva in women.

Along with other type 2 diabetes drugs in the same class, called sodium-glucose cotransporter-2 (SGLT2) inhibitors, Jardiance is used to lower blood sugar levels. It works by helping the kidneys eliminate more sugar from your body through urination. Taking Jardiance and other SGLT2 inhibitors introduces more sugar into your genital area. Bacteria can feed on this extra sugar.

With this infection, bacteria usually enter through an open cut and then infect the tissue beneath the skin and destroy it. It requires immediate treatment with antibiotics and surgery to remove the dead or dying tissue. Catching the infection early, before it spreads, is very important.

Patients taking Jardiance or other SGLT2 inhibitors, including Invokana, Farxiga and Steglatro, should seek medical attention right away if a fever develops along with tenderness, redness or swelling in the genital area, as this may be a sign of Fournier’s gangrene.

Very few people get this rare infection, but research has found that the mortality rates of Fournier’s gangrene vary and can be quite high. The mortality rate can range from 20% to 50%, according to a study published in the World Journal of Emergency Surgery. Those who survive often require ongoing care after surgery to help heal wounds and recover function in their genital area.

One study found 55 cases of Fournier’s gangrene among people taking SGLT2 inhibitors between March 2013 and January 2019, which is almost triple the number of cases identified among patients taking other antidiabetic drugs between 1984 and January 2019. However, it’s hard to know if these cases were definitively caused by SGLT2 inhibitors, and the risk of getting Fournier’s gangrene while on these drugs remains low.

Kidney problems and ketoacidosis are other rare and serious side effects of Jardiance.

Jardiance also has more common and treatable side effects, including yeast infections, urinary tract infections and increased urination.



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Aug 1, 1992·Clinical Otolaryngology and Allied Sciences·S R WilliamsA P Brightwell

Jun 1, 1988·The British Journal of Ophthalmology·R Walters

Jan 25, 2014·Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India·Jagdish SadasivanAnandh Balasubramaniam

Dec 1, 1995·American Journal of Ophthalmology·A ShayeganiM E Grossman

Jan 1, 1991·Ophthalmology·J W Kronish, W M McLeish

Jun 1, 1988·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·R J BalcerakR C Bosack

Oct 1, 1989·Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons·R D MargolisW W Weiss

Aug 1, 1987·The British Journal of Oral & Maxillofacial Surgery·P G McAndrewR W Griffiths

Jun 1, 1968·American Journal of Surgery·S M Strasberg, M S Silver

Feb 1, 1995·The Annals of Otology, Rhinology, and Laryngology·J H GreinwaldP G Haggerty

Jan 1, 1996·The Journal of Laryngology and Otology·A R BanerjeeA A Moir

Jul 1, 1995·Head & Neck·D E HenrichW W Shockley

Apr 1, 1984·The Journal of Dermatology·V N Sehgal, K Singh

Jun 1, 1984·Otolaryngology–head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery·E M SpankusR H Miller

Mar 20, 1999·Infection and Immunity·S LukomskiJ M Musser

The Graveyard of Old Diseases

The global doubling of human life-expectancy—the most-important thing that ever happened—would not have been possible without dramatic improvements in nosology, the classification of human diseases. In 1850, medical diagnostics were rudimentary, autopsies were rare and reliable data scarce. The nosology created for the 1850 Mortality Census, then, was inevitably crude: 300,000 Americans were reported as having died in 170 ways, many of which we wouldn’t recognize and some of which weren’t even deadly. Abscess, canker, carbuncle, cramp, eruption, hemorrhoids, spasms, teething, tetter, thrush, and worms do not normally kill. More likely people died with these things not of them. Even so, what I find compelling about the 1850 nosology is not its medical accuracy but what it reveals about a people trying to discipline death to careful categories. Certainly some of the categories reveal more about the data collectors than their world. The independent listings for “menses, excess of” and “menses, suppression of” reveal a typically male preoccupation with, and misunderstanding of, female biology. Other categories, however, reveal something important about the nineteenth century—the fact, for instance, that many people were dying of simple vitamin deficiencies. In many cases, the deaths by black tongue, chlorosis, jaundice, rickets, scurvy, and perhaps even dirt-eating could have been cured with a simple multivitamin or a more steady, sensible diet. Categories like cancer, “heart, disease of,” and apoplexy (stroke or aneurism) map neatly to our own understanding of how people typically die. Other categories are so arcane that they need to be defined.


abscess  > An abscess, or a boil, is raised, swollen bump filled with puss. Found on both internal organs and external tissue, abscesses have multiple causes, including viral bacterial infections and as a side effect or symptom of numerous medical conditions. In the nineteenth century, typical treatments included poultices and lancing.

apoplexy  > Apoplexy is a stroke or brain aneurysm, which results in confusion, unconsciousness, and partial or total paralysis. According to nineteenth-century doctor Egbert Guernsey, the illness was most prevalent in women, older adults, and those with “a stout short body, large and short neck, corpulence, dark, red countenance.” A fit of apoplexy, he believed, could be induced by sudden temperature changes, excitement, alcohol abuse, drugs, or, in men, tight neckties. People having apoplectic attack were told to remove tight clothing, consume belladonna, and call for a physician. [1]

atrophy  > Atrophy is the degeneration of tissue, muscles, organs, or bones. As a broad category, it can refer to medical conditions as diverse as osteoporosis, heart disease, thyroid disease, or menopause. Resulting from aging, malnutrition, illness, disease, or other causes, atrophy usually progresses gradually and is not always life threatening. In the nineteenth-century, A Dictionary of Practical Medicine recommended that “vital energy” be restored to the atrophied body part by improved nutrition, tonic powders, or bleeding. In some instances, atrophy was considered a fatal condition while in other cases it was labeled a “natural” component of aging. [2]

black tongue  > Black Tongue, as the name implies, is a dark discoloration of the tongue, often indicative of typhoid or diphtheria. As a highly contagious infection, individuals with “Black Tongue” were regularly quarantined. According to the The American Journal Medical Sciences, treatment included nitrate silver and “as much brandy as the patient can digest.” In the late nineteenth and early twentieth centuries, Black Tongue could also be a symptom of a fatal vitamin deficiency, commonly found among impoverished infants and children. Cattle, too, can also die of Black Tongue. [3]

canker  > Commonly found in infants and children, a canker is an oral ulcer or sore located on the lips or mouth, which can cause the gums to swell and recede from the teeth. Usually a minor complaint, nineteenth-century treatments included dabbing the canker with nitrate of silver, sulphate of copper, iodine, or, in persistent cases, mercury. Doctors advised nursing women who were experiencing recurring cankers to wean their child in order to obtain relief.

canker rash  > Canker rash is a form of scarlet fever with ulcerations or putrid sore throat. Considered more common among children than adults, William Andrus Alcott described the condition as “a very troublesome disease,” not infrequently fatal. “Physicians dread it almost as much as they do the small-pox.” Symptoms included chills, fever, sore throat, and a skin rash. Treatment included bed rest, “cooling drinks given freely,” “abstinence from animal food,” or a cold compress. [4]

carbuncle  > Carbuncles are a grouping of inflamed, puss-filled bumps on the skin, larger than a boil or abscess. According to A System of Surgery, a carbuncle, larger or equivalent in size to a human hand, usually formed on a patient’s neck, shoulders, back, or buttock. If caught early, nineteenth-century physicians lanced the carbuncle using a “tenotomy knife.” Infected carbuncles, however, often developed into gangrene, leading to amputation or death. [5]

catarrh  > Often a symptom of the common cold, hay fever, influenza, strep throat, or sinus infections, catarrh is the inflammation of the airways in the throat, nose, or mouth, causing an accumulation of mucus and phlegm. Originating from a Greek verb meaning “to flow down,” catarrh most often referred to the common cold in nineteenth-century America. According to Dr. Alfred Catherwood of London, temperature changes or cold spells did not, in fact, cause catarrh or the common cold; instead, he believed that “moisture with cold, miasma, noxious gases, and impalpable powders” were to blame. [6]

chlorosis  > Chlorosis, or the “green-sickness” as it was known in the nineteenth century, is anemia caused by iron deficiency. According to Homoeopathic Domestic Practice, chlorosis often occurred in adolescent girls, young women, or “occasionally in the young and delicate of the male sex.” Affecting the richest and poorest segments of society, Egbert Guernsey claimed, “servants, and especially cooks, are particularly liable to this disease, but the delicate and inert habits of the rich not less frequently lead to this affliction.” Indicated by paleness, brittle finger nails, swollen ankles, and irregular menstruation, those suffering from chlorosis were advised to eat a wholesome diet, get plenty of exercise, and take in some fresh sea air. [7]

chorea  > Chorea, or “Saint Vitus’s Dance” as it was known in the nineteenth century, affects the nervous system, causing sudden, uncontrolled movement in the face and extremities. Today, chorea would be diagnosed as Huntington’s disease or another genetic neurological condition. In the 1840s, the London Medical Gazette reasoned “that the emotions of the mind affect the part of the brain which is most nearly connected with the points of implantation of the auditory and optic nerves.” [8]

croup  > Found in infants and children under the age of five, croup, also known as cynanche trachealis, is an infection that results in the swelling of the larynx and the obstruction the upper airways, causing shortness of breath or even suffocation. Indicated by raspy breathing and a cough that sounds similar to the barking of a dog or seal, the victim experiences violent, sporadic attacks of coughing and shortness of breath at night. In the nineteenth-century, severe cases resulted in death and, according to Homoeopathic Domestic Practice, “the mother who has watched with bitter agony the fearful struggles of her child, breathes a sigh of relief as the last breath is drawn, and as the look of anguish changes to the sweet calm of death, she knows that suffering is over, and her little one is at rest.” [9]

debility  > Debility indicates a temporary or chronic weakness of the body and is a symptom of various physical and mental illnesses. Often associated with vice or moral failure in the nineteenth-century, one moralist warned “Youth and Manhood” against debility, which could result from genetics, “overtaxed energies,” “objectionable habits,” “disease of impudence,” age, marriage, or “nervous” conditions. Claimed to be caused by modernity, this widespread disease reputedly affected “a majority of the human race” to one degree or another. [10]

dirt eating  > Now labeled as geophagia or pica, dirt eating is a symptom of anemia, internal parasites, vitamin imbalance, or mineral deficiency. Rather than ingesting just any type of dirt, Southerners consumed “white dirt,” which is actually kaolin, a chalky clay substance used in the manufacturing of paper and paint. In the 1860s, Austin Flint described dirt eating as “a morbid habit which prevails, to a considerable extent, among plantation negroes of the Southern States.” To prevent them from eating dirt, Flint recommended that slaves be chained to plank floors or gagged with iron or tin face masks. Poor white southerners also consumed dirt in the late nineteenth and twentieth centuries and, according to an 1894 study, twenty-six percent of Dr. Sandwith patients confessed to “earth hunger.” [11]

dropsy  > Dropsy, swelling caused by a fluid buildup, is a symptom of kidney disease or congestive heart failure and can affect the lower exterminates, abdomen, or chest cavity. According to mid-nineteenth-century author Horatio Goodday, over half of deaths from dropsy could be prevented with “good air; suitable clothing, and shelter against excess of damp, cold, and heat; cleanliness, proper food; exercise; rest; and the right observance of the Sabbath.” Other medical treatments included aspis-mel, arsenicum, digitalis, hellebore, dulcamara, and crotalus. Cases of dropsy were often deadly and physicians recommended drawing out the fluid to relieve the patient’s suffering and prolong life.

erysipelas  > Erysipelas, also known as St. Anthony’s Fire or Rose, is a bacterial skin infection, causing fever, redness, swelling, inflammation, and a burning sensation. In the nineteenth-century, doctors considered newborn infants, alcoholics, and menstruating women most susceptible to the condition. Treatments include bleeding, a vegetable-based diet, and fresh air as well as doses of aconite, belladonna, and rhus. In humans, erysipelas is not usually fatal though it is often fatal for pigs. [12]

bilious fever  > Bilious fever is an unspecified fever causing nausea and vomiting. In the nineteenth-century South, yellow fever and bilious fever often occurred in the same epidemics and were studied in tandem. According to Homoeopathic Domestic Practice “it is the endemial fever of warm climates, particularly where the soil is marshy, the country new, and the vegetation rich.” The South, especially the “very unhealthy” coastline of South Carolina, was considered breeding ground for bilious fever. Often deadly, treatment for bilious fever included the “water cure,” ipecac to induce vomiting, or aconite to reduce pain and inflammation. [13]

catarrhal fever  > Catarrhal fever is a viral disease causing sneezing, coughing, fever, and body aches; today it would be diagnosed as influenza. Thought to be caused by exposure to either damp or cold weather, Franz Hartmann recommended “rest by a very warm stove” and a dose of “nux,” arsenic, or “rhus.” Even in the nineteenth century, most individuals recovered from catarrhal fever within a few days or a week. [14]

ship fever > Ship Fever, or epidemic typhus, is a bacterial infection spread by lice and fleas. Common in crowded, unsanitary conditions, nineteenth-century ships proved the prefect breeding ground and, in 1850, Henry Grafton Clark reported that ship fever “has been seen on board emigrant ships, in the quarantine hospitals, and among emigrants newly arrived from Europe.” Expounding on the plight of the immigrant victim, Clark concludes “it is familiar in the hovels and ill-drained and ventilated house of the poor and wretched. It takes passages with the poor emigrant, who seeks out hospitable shore an asylum from his woes; it wastes his strength on the long passage, and at last, with its fiend-like gripe, thrusts him down into the deep and sorrowful ocean, or only spares him from this, that he may find but a ‘hospitable grave’ upon the shores of the country of his most ardent hopes and expectations.” Treatment included cleanliness, ventilation, “Dover’s Powder” and a dose of camphor, spirit of nitrate, or “liquor ammoniae acetatis.” According to nineteenth-century doctors, those who recovered from ship fever often experienced delirious episodes during the course of the illness. [15]

fistula  > A fistula is an abnormal connection between two epithelialized surfaces, such as veins, nose, ear, liver, intestines, rectum, urinary track, and female reproductive organs. Aggravated by repeated pregnancies and forceps deliveries, nineteenth-century women suffered from vesico-vaginal fistulas. Men more commonly had anal fistulas. Usually fistulas were minor complaints and patients, as a form of treatment, received a probe up the affected body part, ingested a laxative, applied zinc ointment, or, in more extreme cases, surgery. [16]

fluor albus  > Fluor albus, or leucorrhcea, is a white, milky discharge from the vagina, indicative of normal hormonal changes or infection. According to Egbert Guernsey’s Homoeopathic Domestic Practice, the condition was caused by the suppression of menstruation, constipation, childbirth, the “free use of tea and coffee,” “excessive sexual indulgence,” and “frequent child-bearing.” Upper-class women, “mind excited by the luxuries and stimulants of the table, the excitements of the ball-room or theatre, and the glowing and sometimes impure pages of a certain class of fiction,” were deemed particularly susceptible to fluor albus. Treatment included daily exercise, ingesting zinc sulphate or nitrate of silver, and injecting cold water up the vagina. [17]

gout  > Typically a non-life threatening complaint, gout is a form of arthritis caused by a buildup of uric acid in the joints. According to Dr. William Harvey, gout is “the inheritance of those past the middle age” and was caused “from excess of good living, sedentary habits, [and] mental occupations.” The disease was similar to rheumatism but often more acute and more likely to affect smaller joins. “Apply . . . thumbscrew to the thumb, and turn it until the pain is as severe as can possibly be endured, and that is rheumatism. Now give it one more turn, and you have gout,” claims a “gentleman” in Homoeopathic Domestic Practice. [18]

hemorrhoids  > Hemorrhoids, also known as piles, are enlarged, swollen veins in the anus and rectum, which cause bleeding. Even in the nineteenth century, individuals did not actually die from hemorrhoids, but the diagnosis occasionally appears as the listed cause of death on death certificates. As doctors noted in The Cyclopaedia of Practical Medicine “individuals affected with hemorrhoids die usually of some other complaint, which, being urgent and prominent. . . . engrosses the attention during life and at the post-mortem examination.” [19]

hives  > Hives, also referred to as cynanche trachealis during the nineteenth century, is a sink rash, resulting in itchy, red or pale-colored welts upon the body. Although commonly considered a cause of death among nineteenth-century infants and children, hives was, in fact, a symptom of other, fatal illnesses, such as coup. [20]

whooping cough  > Whooping cough, known as pertussis in the twenty-first century, is a respiratory-tract infection that causes fever, headache, congestion, and a violent, whoop-like cough. Girls were considered more susceptible to whooping cough than boys in the nineteenth-century. During coughing attacks, children were said to experience “great anguish and restlessness.” Whooping cough was considered potentially fatal if it lasted longer than four weeks. [21]

hydrocephalus > Often effecting infants and children, hydrocephalus, or “water-stroke,” is the accumulation of fluid deep within the brain. Symptoms included headache, vomiting, fatigue, fever, and, in the final stages of the disease, convulsion, unconsciousness, and death. Treatments included cold compresses to the head and a dose of aconite or belladonna. Extremely deadly in the nineteenth century, hydrocephalus “kills more than recovers.” [22]

hydrophobia > Hydrophobia is rabies. After being bitten by an infected animal, the patient gradually, over a period of weeks or months, develops inflammation near the bite, an open wound, chest pain, heart burn, excess saliva secretion, and stiffness in the neck and throat. According to Homoeopathic Domestic Practice, the patient then developed a haggard appearance with “sunken, but still brilliant” eyes and “delirium of a wandering or violent character” and a “constant inclination to bite.” Hydrophobia was “one of the most fearful and agonizing diseases on record, and what adds still more to the terror inspired by its name, but very little success has as yet been met with, in its treatment.” In most all cases, hydrophobia resulted in death, “a welcome messenger to relieve the poor victim of his tortures.” [23]

influenza  > Influenza, or catarrhal fever as it was also known during the nineteenth century, is a viral disease causing sneezing, coughing, fever, and body aches. According to Dr. Thomas Harrison Yeoman, patients’ “spirits are depressed almost to a state of melancholy; the mind wanders from every agreeable or social idea; . . .the temper is irritable, peevish, and discontented, and the invalid cares only to wrap himself up in his own misery, and the warmest blanket he can find.” In the nineteenth-century, treatment included a nourishing diet as well as a dose of camphor, arsenic, or mercury. Most individuals recovered from influenza within a few weeks, but bad cases could turn fatal. [24]

intemperance  > Intemperance is a lack of restraint and moderation and, in the nineteenth century, most often applied to alcoholics or drunkards. Considered a sin and moral failing for most of the nineteenth century, intemperates, Heman Humphrey declared in 1813, were traveling “the high road to hell.” More than just a medical condition, nineteenth-century reformers declared intemperance a social ill contributing to social violence, divorce, poverty, and suicide. Treatment for intemperance varied considerably and patients, especially those institutionalized as a result of their condition, were recommended to attend church, pray, abstain from hard liquor and stick to wine or ale. [25]

jaundice  > Caused by an excess of bilirubin in the bloodstream, jaundice is a yellowing of the skin and eyes that affects infants, children, and adults. It can be a symptom of numerous medical conditions, including liver failure, gallbladder problems, pancreatic cancer, alcoholism, typhoid fever, cholera, dysentery, or snake bite. Jaundice rarely kills, but in the nineteenth century, jaundice could be listed as a cause of death. In these cases, it is more likely that jaundice was a symptom of a fatal illness rather than the actual cause of death.

leprosy  > Referred to as “Hansen’s Disease” in the twenty-first century, leprosy is a long-term bacterial infection that causes disfiguring sores and nerve damage. Today the disease is treatable, but there was no cure during the nineteenth century. According to the New York Medical Journal, leprosy was extremely contagious and “the whole history of leprosy . . . marks it as a disease that had propagated itself by human intercourse, and has extended its ravages as its human vehicle, man, had carried it from one land to another.” Doctors recommended quarantine, outdoor exercise, and fresh air. In the nineteenth and twenty centuries, a leper colony existed in Hawaii on the island of Kalaupapa. [26]

malformation  > Malformation is bodily disfigurement and can affect any body part, including, but not limited to, ears, toes, fingers, limbs, rectum, anus, or reproductive organs. In the nineteenth century, these cases could be caused by an accident, but were more likely the result of birth defect or genetic condition. The severity and treatment depended upon the body part affected. For example, cases of rectum or anus malformation most often occurred in men, were treated by lancing the afflicted area, and often proved fatal. On the other end of the spectrum, toe or foot malformations caused disfigurement but rarely death. [27]

mania-a-potu > Mania-a-potu, also known as “mania from drink,” “Brain Fever of Drunkards,” or “delirium tremens,” is mental illness resulting from alcohol consumption. Today, the condition would be simply labeled as alcoholism or alcohol withdrawal. According to the Journal of Nervous and Mental Disease, symptoms include “mania,” a period of delirium after consuming alcohol or a strong desire for drink. According to Samuel Henry Dickson, mania-a-potu begins with a craving for alcohol, vomiting, irregular bowel movements, and “fetid breath.” In its final stages “the patient wanders; he mutters incoherently, and with incessant restlessness; or if he sinks exhausted into a brief and unquiet slumbers, starts from it in terror with cannot be soothed.” Edgar Allen Poe described the condition as a ten-day period of “hallucination, arising from an attack,” during which he endured “horrible unspeakable torments.” The Elements of Medicine claimed that men in this condition had a predisposition toward suicide. [28]

marasmus > Typically occurring in infants and young children, marasmus is malnutrition, resulting in emaciation, and can be either an independent cause of death or a symptom of another fatal disease. Patients lose their desire for food, vomit after eating, “waste away,” and die. In the nineteenth century, symptoms could be relieved with nourishing soup, wine, or “vegetable tonics,” but doctors could not “cure the disease, for it is the natural disease of death.” [29]

excess of menses  > Excess of menses, known as menorrhagia in the twenty-first century, is a hormonal imbalance causing prolonged menstruation or heavy bleeding. According to On the Treatment of Diseases of the Skin, excess of menses was caused by “disease of the sexual organs,” “unaccustomed stimulus,” or “excess” intercourse. The recommended treatment was abstaining from sexual activity for “a season” and then having “moderate use of it.” Treatment was “imperfectly accomplished” if the “marriage is sterile, and especially those in which, from disparity of year or from constitution feebleness on the husband’s part, the act is but imperfectly accomplished.” Nineteenth-century prostitutes experienced the condition because of “constant over-excitement of their sexual organs.” [30]

suppression of menses  > Suppression of menses, known as amenorrhea or Gn Rit agonists in the twenty-first century, is caused by a hormonal imbalance, pregnancy, or the onset on menopause. After several months of suppression, women were pale, “enfeebled” and have “a train of nervous symptoms.” According to On the Diseases Peculiar to Females, sudden suppression of menstruation was caused by exposure to cold, dampness, or a “great anxiety of mind, and sudden fright.” Treatment included wine, colocynth and calomel pills, “Dover’s powder,” laudanum, bleeding, and an abdominal compress of “warm poppy heads.” In the nineteenth century, suppression of menses appeared as a cause of death. [31]

mercury poisoning  > Considered toxic to the nervous, digestive, and immune systems, mercury causes tremors, mouth sores, loss of peripheral visions, swollen gums, muscle weakness, speech impediments, memory problems, loss of movement, and death. Often proscribed in small doses as a medication in the nineteenth century, mercury was a readily available substance that was considered beneficial to healing. Mild symptoms of the disease included trouble swallowing and a metallic taste. According to A Treatise on Therapeutics, those with extreme cases of excess mercury poisoning experienced the loosening of the teeth, gangrene, mouth hemorrhages, and “in not a few instances, death had taken place, or recover has been attended with revolting or very inconvenient deformity.” [32]

milk sickness  > Today considered an extremely rare form of food poisoning, milk sickness was caused by drinking the milk of a cow that had ingested white snakeroot. In the early 1800s, the condition was known as a “mysterious disease” or “Sick-stomach” and was extremely fatal. Often an epidemic affecting southern and western communities, numerous rural families would fall ill around the same time. According to A Kentucky Sampler, symptoms included nausea, dizziness, vomiting, swollen tongue, and, right before death, “a pronounced odor on the breath and in the urine.” Treatment typically include opium, brandy, charcoal, strychnine, or blood-letting. Only in the late 1910s and early 1920s, did doctors realize that white snakeroot caused milk sickness. [33]

mortification  > Mortification, a decaying, degeneration of a body part, is a symptom of gangrene or an unspecified infection. Often occurring after an injury, surgery, or frostbite, mortification caused the afflicted limb “to become quite cold” and turn “a brown, livid or black color” as “the scarf-skin is raised up in little tumors from the gas which is disengaged by the decomposing flesh; a very offensive odor is emitted.” In the nineteenth-century, the only treatment option was often amputation, which may prolong life or may induce shock and death. [34]

neuralgia  > Also known as “tic douloureux,” neuralgia is a stabbing or burning pain along a nerve and is a symptom of aging, multiple sclerosis, cancer, shingles, or an infection. According to Godey’s Magazine, the pain was a “plunging, darting pain of the most intensive and agonizing kind.” Causes of the illness included exposure to dampness or cold and “in this way, railway travelling has proved a fertile source of neuralgic affliction.” Treatment included a warm compress, “removal . . . to a dry, warm air” or a dose of chloroform, carbonate of iron, or croton-oil. Once afflicted with neuralgia, patients were considered more susceptible to other conditions, including stomach disorders and “anxiety of [the] mind.”[35]

onanism  > Onanism, masturbation or ejaculation outside of a vagina, was considered an illness or moral failing in nineteenth-century America. According to the Old Testament, Onan withdrew his penis prior to ejaculation and “spilled his seed on the ground;” this condition was named after the “Sin of Onan.” In the mid-nineteenth century, it was considered hard to cure and Dr. John Hilton knew “of no way to prevent onanism except by freely blistering the penis, in order to make it raw and so sore that it cannot be touched without pain.” Mocking this medical condition, Mark Twain’s “Thoughts on the Science of Onanism” concluded: “If you must gamble away your lives sexually, don’t play a lone hand too much. When you feel a revolutionary uprising in your system, get your Vendome Column down some other way – don’t jerk it down.” [36]

paramenia  > Paramenia is irregular or abnormal menstruation. For women over the age of fifty, paramenia usually indicated the continuation of menstruation and a delayed onset of menopause. For women under the age of fifty, paramenia indicated irregular menstruation of amenorrhea, which frequently occurred after pregnancy and childbirth. According to Doctor John Mason Good, treatment included laxatives, epsom salts, cold compresses, opiates, or bloodletting. [37]

peritonitis  > An inflammatory condition, peritonitis affects the lining of the abdominal wall, intestines, uterus, or other abdominal organs. In the nineteenth century, peritonitis could be a symptom of cancer, tuberculosis, kidney failure, pancreatitis, stomach ulcer, ruptured appendix, or a gastrointestinal condition. Labeled a “disease peculiar to women,” peritonitis of the uterus was considered a commonality in “laying-in hospitals” during the 1840s. Regardless of the organ affected, however, treatment included opium and morphine; peritonitis was usually fatal. [38]

pleurisy  > Pleurisy, or inflammation of chest and lung tissue, is a symptom of influenza, pneumonia, cancer, tuberculosis, heart failure, or blood clot in the lungs. In addition to chest pain and a dry cough, the patient experienced flushing, chills, fever, and a rapid pulse. According to Homoeopathic Domestic Practice, pleurisy was commonly caused by “exposure to cold and dampness” and could be treated with aconite and bryonia.” Most recovered from pleurisy. Indeed, Dr. Austin Flint determined that is fatal in “only a small proportion of cases” during the 1850s. [39]

puerperal fever  > Puerperal fever, or “Child-Bed Fever,” is caused by an infection of the uterus. Today this condition is diagnosed as maternal sepsis. Occurring during or after delivery, women experienced fever, a rapid pulse, thirst, and radiating pain in the abdomen. Published in 1856, Egbert Guernsey’s Homoeopathic Domestic Practice considered puerperal fever “the dread of mothers.” Considered a serious and often fatal condition, medical advice recommended that a physician “be consulted without delay, for if allowed to go on, it may gain a fearful ascendency.” Once obtaining a physician, treatment included a dose of aconite alternated with bryonia or belladonna. In the early and mid-nineteenth century, doctors considered puerperal fever the most lethal in January-March births. [40]

putrid sore throat  > Known in the twenty-first century as strep throat or diphtheria, putrid sore throat is a bacterial infection of the tonsils or mucous membranes. Also referred to as malignant sore throat or ulcerous sore throat, putrid sore throat produced cankers, sores, and abscesses around the throat or mouth. Beach’s American Practice Condensed claimed that it was caused by infection, cold, or “neglect of cleanliness, unwholesome air, [or] damaged provisions.” Treatments included bleeding, mercury, ligament, wine, a mixture of yeast and milk, or a poultice of plaster or resin and “brown soap.” [41]

quinsy  > Quinsy, or peritonsillar abscess, is a bacterial infection causing inflation behind the tonsils. In the nineteenth century quinsy could be a symptom of a sore throat, common cold, tonsillitis, or paristhmitis. According to The London Lancet the word ‘quinsy’ is of somewhat uncertain application, and that it is probably used to express more than once complaint.” Treatment included chlorate of potash, poultices, inhaling warm steam, beef-tea, and drinking “small quantities of wine or brandy every four hours.” Presumed to be caused by exposure to cold or “insanitary conditions in dwelling house” cases appeared “in groups, and two or three cases are often known to occur at once, or successively, in badly drained and ventilated houses.” [42]

rickets  > Typically caused by a Vitamin D deficiency, rickets is the weakening of children’s bones. Described by Dr. Eustace Smith as “one of the most preventable” but common children’s illness, rickets caused deformities of the skull, bowed legs, curvature of the spine, bodily malformation, developmental delays, and, in some cases, death. Differing from a healthy child, “a rickety child is only happy when at rest. . . to look at him we are irresistiblely reminded of the other term of life, for he appears to have anticipated at least once consequence of the weight of years, and to have combined the patient endurance of old age with the face and figure of a child.” In order to prevent or treat rickets, nineteenth-century doctors recommended a healthy diet, fresh air, plenty of cow’s milk, bodily cleanliness, and a flannel dressing across the abdomen. [43]

scrofula  > Scrofula, also known as the “King’s Evil,” is a tubercular, bacterial infection of the lymphatic glands. In Europe, from 1003 to 1825, the touch a British or French monarch was thought to cure scrofula and kings and queens held large ceremonies in which they touched those afflicted with the disease. By the mid-nineteenth century, doctors considered scrofula the “Parent of diseases,” since they believed the condition could affect any body part or organ and often misdiagnosed rickets, rachitis, white swelling, consumption, and ulcers as scrofula. In 1856, Egbert Guernsey though that those with a “tuberculous constitution”— described as having a “large   head, short, thick neck, light hair, fair   skin   and rosy cheeks, generally blue   eyes   and large pupils” and a “full and rounded, but . . . soft and flabby” form—were especially susceptible to the condition. According to Gurnesy, scrofula was caused by vaccinations, damp air, cold air, meals, small pox, medication, “eating heavy indigestible   food in the first years of infancy,” or “nursing from a scrofulous or syphilitic nurse.” [44]

scurvy  > Scurvy, produced by a vitamin C deficiency, can cause anemia, exhaustion, bleeding, bodily soreness, swelling in the extremities, mouth ulcerates, receding gums, and the loosening of the teeth. Discovered by 1753 by James Lind, a British naval surgeon, scurvy was associated with sailors, soldiers, paupers, prisoners, and residents of lunatic asylums. To prevent or treat scurvy, nineteenth-century doctors recommended the consumption of fruits, vegetables, citrus, lemon juice, and, especially, potatoes. Medical treatments included mercury, arsenic, sulphur, and nux. [45]

teething  > Occurring in infants between four to seven months of age, teething produces a mild temperature as well as swollen and inflamed gums. In the nineteenth-century, “the period of teething is the most critical of childhood,” according to A Practical Treatise on the Diseases of Children. Teething infants often experienced vomiting, fever, diarrhea, bleeding of the mouth, and an “irritated state of some of the organs.” Treatment included cold water and allowing the child to chew on coral, ivory, or gum elastic. Although considered a minor ailment or inconvenience today, teething could be deadly in the mid-nineteenth century. [46]

tetanus  > Tetanus, or lockjaw, is a bacterial infection that enters the body through an open wound. According to Homoeopathic Domestic Practice, the illness could be caused by a splinter, a blow on the back, a fever, “suppressed menstruation,” or a “violent exertion of the mind and body.” The afflicted patient experienced a tightening in the head and neck, a difficulty opening the mouth, and, then, a clenching of the jaw. Gradually, all of the voluntary muscles in the body tightened and demobilized. Regardless of the treatment, the disease was most often fatal. [47]

tetter  > Tetter is a skin condition causing redness and vesicular outbreaks; it can be a symptom of acne, herpes, eczema, psoriasis, lupus, ringworm, or shingles. According to John W. Comfort, “every variety of tetter may be produced by constitutional disorder, and as a general rule it is brought on by derangement in the system” Treatment included, “a liberal use of purified charcoal,” bitter tea, nightly lobelia pills,   a bland bread-based diet, outdoors exercise after meals, and “a change of residence from one part of the county to another, or from the city to the country.” [48]

thrush  > Often occurring in infants and children, thrush is a fungal infection of the mouth mucus membrane, which causes white spots and mouth ulcers. Egbert Guernsey claimed that thrush was caused by a “constitutional taint,” poor diet, or “in those who are fed with the bottle or spoon.” Treatment in mild cases included a mixture of borax, “loaf sugar,” and water. In more severe cases, doctors recommended powered mercury or sulphur. [49]

venereal disease  > A sexually transmitted disease, the most common venereal diseases were syphilis and gonorrhea during the nineteenth century. According to the Report on the Extent of Venereal Disease, “no diseases of a preventable character cause[s] greater evils among society at present in this country than these do.” In London’s St. Bartholomew’s Hospital half of the out-patient cases were a result of venereal diseases. With few hospital or workhouse beds available for these patients, British prostitutes, who were “suffering from these diseases,” struggled to gain admittance and “being rejected, are forced to go on with their trade in order to live.” The cause of venereal disease eluded nineteenth-century doctors, and Dr. Philippe Ricord believed “the venereal virus to be small living worms which produce eggs by copulation, and which, like other insects, can readily multiply. . . these venereal worms engender others, and thus we may suppose that the syphilitic virus is propagated.” Supposed to have originated in the West Indies, doctors assumed that the disease passed to French military men through intercourse with indigenous women and then on to the rest of the world. [50]

white swelling > White swelling, known as bone tuberculosis or Mycobacterium tuberculosis, is a tubercular, bacterial infection of the bones, causing swelling, stiffness, and fluid accumulation in the joints, especially in the knees or hips. Most often occurring at middle-age or in children, nineteenth-century treatment for white swelling included a liniment containing hemlock oil, croton oil, and tincture of iodine. In advanced cases, doctors recommended splints and bed rest. In the nineteenth century, white swelling could also be wrongly labeled as scrofula. [51]

worms > A symptom rather than an actual cause of death, worms indicated an illness in which parasites were found in the faeces. Believing that worms occurred most in young children and “sickly adults,” William Potts Dewees described the condition as “producing emancipation, a swelled hard belly, gnawing or pungent pain in the stomach, pale countenance, fetid breath, and irritation of the nostrils.” Other symptoms could include coughing, headache, bowel irregularities, vomiting, or unusual food cravings. Treatment for worms varied considerably depending on the other symptoms and could include exercise, a diet of meat broth, or a dose of aconite, ignatia, chia, spigelia, belladonna, mercury, nux, or sulphur. [52]

90,000 dry gangrene of the lower extremities, signs and symptoms

Treatment of dry and wet gangrene in the 21st century does not imply obligatory amputation, and the experience of our center shows this. In most surgical departments of the country, gangrene is still a disease with a high rate of amputation and death.

Simple restoration of blood flow does not allow counting on quick closure of defects in the tissues of 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.

The use in medicine of modern methods of restoring blood circulation in the limb and technologies of reconstructive plastic surgery allows the vast majority of patients to preserve the leg and the ability to walk.Such technologies are concentrated in specialized limb rescue centers, such as the Innovative Vascular Center.

Gangrene can be cured and it is actually very simple. After all, it is enough to restore blood flow to the leg, remove dead tissue and heal the remaining wounds. However, these simple principles are still practically not implemented anywhere, because some doctors and departments restore blood flow, while others are engaged in the wound process and removal of dead tissue.

For the treatment of dry gangrene of the lower extremities, they offer a variety of droppers, blood thinners, vazaprostan and other miraculous remedies. And when it really becomes clear that such treatment of gangrene of the legs does not eliminate the symptoms, then in the usual surgical department one remedy is used – high amputation.

This outcome encourages patients and their families to seek treatment for gangrene without surgery. Various “folk” remedies are used, from which the infection only flourishes.This is chewed bread crumb, and salt and urine and many other “gangrene remedies” applied to the affected area. From them, the inflammatory process develops and spreads faster, inevitably leading to amputation for health reasons.

In such a development of events, in most cases, doctors are indirectly to blame, who perceive any tissue necrosis as the need to “save the patient” by the most radical method of treatment. They either do not know information about modern technologies, or they don’t believe in it and don’t bring it to patients.

Gangrene can be treated without amputation at the Innovative Vascular Center

Treatment of gangrene without amputation in Moscow is carried out in a specialized hospital of the Innovative Vascular Center – the Clinic for Innovative Surgery (KIH). In 2011, according to the ROASH report, our clinic took a leading position in performing vascular reconstructions on the arteries of the lower leg and foot.

The innovative vascular center is a clinic in Russia, where modern high-tech methods of restoring blood flow in the legs, advanced technologies of endovascular X-ray surgery, vascular and reconstructive plastic microsurgery are put on stream.

Every year we successfully operate on more than 650 patients with critical ischemia and gangrene of the legs. A team of experienced vascular and endovascular surgeons, as well as doctors skilled in the management and closure of necrotic wounds, can provide modern gangrene treatment. Such a team is able to achieve impressive results in the treatment of gangrene. This team should include specialists who can not only restore blood flow, but also know how to treat a patient with multiple vascular lesions, severe concomitant diseases and serious wound complications.

Wet gangrene, necrosis, long-term non-healing wounds, black color of the finger are not a reason for amputation for our team, but should be the reason for active surgical tactics to save the limb. We manage to save the leg in most patients with threatening limb ischemia. We are fighting to save the leg to the last opportunity.

In many other “limb rescue centers” there is a division of vascular, endovascular and reconstructive plastic surgery, so there is no possibility of a holistic approach to the treatment of critical lower limb ischemia.

Why are there problems in Russia with the treatment of gangrene without amputation?

  • Vascular surgeons in most clinics in our country are afraid of purulent-necrotic wounds like a fire and do not take patients with necrosis on the foot. After all, they are engaged in “pure” pathology and are afraid of spreading the infection. As a result, only a few clinics are engaged in vascular surgery of gangrene in Russia. The main problem of the vascular and surgical departments is that their doctors do not know much about leg gangrene, symptoms, signs and methods of treatment.Severe pain, symptoms of intoxication, even with the development of dry toe gangrene, are a contraindication for them to perform vascular surgery. Unlike gas gangrene in diabetes mellitus, with dry there is no reason to fear the spread of infection, since the pathological process occurs only in a certain segment of the limb.
  • Endovascular surgeons address chronic arterial insufficiency by removing blockages in blood vessels.However, in case of failure of angioplasty and stenting, the situation usually worsens and it is necessary to immediately do an open intervention, but they do not know it. While the patient gets to the vascular surgeons – the leg may die. Having restored blood flow through the arteries, endovascular surgeons consider their task completed, because they do not deal with wound processes and send patients to the department of purulent surgery, where their leg is calmly amputated, despite good blood flow. When you ask the endovascular surgeons of the federal centers what gangrene of the legs is, its symptoms and treatment, they will not answer you, because there are still no quotas for the treatment of critical ischemia, so the federal center is simply not interested in the treatment of such patients.
  • General surgeons of the departments of purulent surgery have no idea about the level of blood supply to tissues, do not know the methods of reconstructive plastic surgery, which allows closing large wound defects. For them, there is no better treatment for gangrene than to make an amputation, as high as possible, in order to forget about the difficult patient. Even the first signs of gangrene in the initial stage, they consider a threat to the patient’s life and offer to amputate the leg, frightening with possible blood poisoning.

Gangrene of the lower extremities modern treatment

The approach to gangrene treatment differs depending on its causes.In our clinic, the treatment of choice for gangrene of the leg is treatment without amputation. Every year, patients with critical ischemia, who have already been sentenced to amputation in other vascular and surgical departments, are operated on at the inpatient department of the Innovative Vascular Center. For most of them, we manage to keep the leg and the ability to walk. The main reason for the success is the use of advanced technologies and the narrow specialization of our vascular surgeons.

Bypass grafting

Blockage of blood vessels in the vessels and other causes of necrosis of the foot or toe lead to impaired blood circulation.Bypass surgery is an operation to create an additional blood flow path bypassing a blocked area. To do this, an artificial vessel is sewn into the artery above and below the blockage site, through which blood flows below the blockage site, bypassing it. The shunt provides blood to a limb with threatening ischemia. This leads to the restoration of the viability of the tissues around the focus in any type of gangrene, followed by its rejection and healing. Bypass grafting of vessels, in contrast to angioplasty, creates a fundamentally new way of blood circulation.The shunts work long enough to prevent the patient from having their leg amputated. Bypass surgery is an open surgery that takes several hours. It is more effective than angioplasty, but carries a slightly higher risk of complications. If symptoms of dry gangrene of the lower extremities develop, this treatment is the optimal choice in patients without serious concomitant disease.

Angioplasty and stenting

Angioplasty and stenting – differs from bypass surgery in that the path for blood is made through the blocked areas of blood vessels using special instruments.Unlike bypass surgery, this operation is performed without incisions, through a puncture in the artery. After the guidewire is passed through the blocked vessels, they are inflated with special balloons and reinforced with a special mesh – a stent. The patency of the restored areas depends on the level of intervention. Thus, the restoration of the patency of the aorta and iliac arteries (above the groin) usually has a long-term effect, approaching the time of shunts, but in the arteries below the groin and, especially, below the knee, this effect is not always sufficient for the treatment of gangrene.The advantages of angioplasty and stenting are the greater safety of the operation, which makes it possible to use it in patients with severe concomitant pathology. These operations can be performed repeatedly while maintaining an acceptable level of blood circulation in patients. At the Innovative Vascular Center, angioplasty is used to treat gangrene of the foot with lesions of the femoropopliteal segment and arteries in the lower third of the lower leg, most often in combination with open bypass surgery.

Closure of postnecrotic wounds

Treatment of gangrene itself consists in removing dead tissue, treating and preventing the spread of infection from the affected area.It is advisable to perform such treatment after complete restoration of blood flow, otherwise the necrosis will spread. Surgical debridement – cleansing the affected area when dead tissue is removed surgically or with a special VersaJet hydrosurgical device. If blood flow is not restored, it is necessary to perform a full-fledged amputation instead of surgical treatment, since the wounds will not heal without normal blood circulation. Surgeons make a big mistake when they try to treat dry gangrene by removing dead fingers without restoring blood flow, or, on the contrary, ask patients to wait “until it falls off by itself” and recommend smearing dead tissues with potassium permanganate or levomekol.These patients do not receive timely assistance and, as a result, may die or lose a leg. Surgical treatment for wet gangrene is carried out immediately after the restoration of blood flow, and for dry gangrene, after a few hours or days, after the delimitation of the necrotic process. If the affected lesion is not removed, then after the start of the blood, the inflammation and infection spreads quickly, causing symptoms such as fever and palpitations. After the restoration of blood flow, the general condition improves and the process of cleansing the necrotic wound begins.

Often at the site of necrosis, where there was tissue death, granulating wounds are formed. The sore spot is gradually filled with scar tissue and the skin heals. However, sometimes these wounds are located in places of excessive pressure when walking (heel area, ankles), and the area of ​​such wounds is very large. Such wounds cannot heal even with good circulation. In these cases, we use reconstructive plastic surgery. Their meaning is to transplant skin or other tissue grafts from one area of ​​the body, where it is necessary to close the wound.In our clinic, microsurgical operations from the arsenal of plastic surgery are successfully used to close such wounds. In Russia, such treatment and operations for gangrene are carried out only at the Innovative Vascular Center.

Maximum limb preservation from amputation

Symptoms of intoxication that develop in advanced patients require surgical intervention and removal of obvious necrosis of the tissues of the affected area, although in the Innovative Vascular Center it is possible to cure gangrene without major amputation.With dry, and more often wet gangrene, sometimes amputation of a segment of the limb is an inevitable necessity in order to save the patient’s life or with the absolute impossibility of preserving the affected area, where gangrene develops due to the absence of blood vessels. The latter postulate is increasingly being refuted by our ability to treat gangrene. If earlier, in our clinic, it was possible to save only 80% of the limbs with necrosis of the foot and lower leg, then with the introduction of microsurgery, hybrid and plastic vascular interventions, we already save 96% of the limbs affected by gangrene even in diabetes mellitus.

Amputation has now become an exceptional rarity in our practice. Only when it is impossible or irrational to preserve the limb, we carry out these sweeping operations, which we perform within healthy tissues. Most often, we consider it possible not to amputate the leg, but to remove only the affected parts of the limb. To do this, we always first do revascularization (eliminate circulatory disorders), and then remove obviously dead tissue. It never happens with gangrene of the easy path, ordinary amputation leads to profound disability and rapid death, and vascular reconstruction is a very difficult but effective intervention for any type of gangrene.

Hybrid surgery in the treatment of dry gangrene without amputation

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

Prognosis after gangrene treatment

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

More details about the methods of treatment:


Valery Viktorovich Yegmenov Says:
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February 29, 2012 at 12:32 am

I learned about the Innovative Vascular Center for the Treatment of Gangrene on the Internet. The specialists of the center apply the methods of microsurgical bypass grafting in their daily practice. All of them are developed in one of the leading diabetic foot clinics in Germany.The main goal in gangrene treatment is to provide blood flow to the affected area. If large vessels can be restored in many vascular departments, then when the arteries of the lower leg are blocked, only a few surgeons do this. In this clinic, more than 400 operations on the arteries of the leg and foot are performed annually, thanks to which about 90% of the legs with gangrene of the toes and feet are preserved.
Treatment of gangrene without amputation.
All these operations are the hallmark of the Innovative Vascular Center, of which there are only two in Russia.The diameter of the arteries on the lower leg is very small and there are not many vascular surgeons who know microsurgery. In addition to the skills of microsurgery, angiosurgeons have a detailed idea of ​​the mechanism of blood circulation in the affected leg and know methods for preventing thrombosis. The clinic uses a technique to restore blood flow in the foot and lower leg at the microscopic level. Patients usually become patients who have been repeatedly operated on in other clinics or those who have been refused reconstructive reconstructive surgery due to damage to the small arteries of the lower leg.The doctors of the clinic are able to save the leg in 90% of patients with atherosclerosis, 80% with diabetic gangrene and 75% of patients with the disease
Operations on the aorta and upper third of the thigh are widely used in vascular surgery. However, many vascular surgeons are stopped from shunting by signs of gangrene, advanced age of patients and associated diseases. The results of the operations are good: the mortality rate is no more than 5%, the patency of the shunts is 90% for more than 5 years and 75% for more than 10 years. However, given that the majority of patients with aortic lesions are elderly, the risk of surgery increases markedly.Although the long-term results of intravascular interventions are somewhat inferior to open surgeries, the low risk of dangerous complications, the possibility of repeated procedures and the relative cost-effectiveness allow the active use of minimally invasive methods in elderly patients at high risk.
Conservation tactics for gangrene.
1. The maximum possible restoration of blood circulation in the leg, even with the onset of gangrene. This approach allows the doctors of the Center to preserve “half-dead” cells and tissues and contributes to their clear separation from the dead part.
2. After that, after 2-3 days amputation is performed at the lowest possible level. Whenever possible, surgeons limit ourselves to amputation of fingers and their parts. In the most difficult situations, amputation is performed below the knee. The preservation of the knee joint is very important for the subsequent rehabilitation of patients. The rehabilitation center puts patients on a prosthesis 5-10 days after the amputation of the lower leg and teaches them to walk.
3. Only in patients with gangrene above the knee and very elderly patients with poor general health, amputation of the thigh is performed for health reasons and without vascular reconstruction.Reducing the level of amputation in gangrene allows for maximum restoration of gait function. In the clinic, with advanced gangrene, small amputations (fingers, feet, shins) are practiced after the restoration of arterial blood flow. Rarely, primary amputation of the lower leg is performed. In all cases, doctors strive to create a support stump of the lower leg, which facilitates prosthetics. For rehabilitation and training in walking on a prosthesis, a special rehabilitation department has been created there, where patients have the opportunity to fully restore mobility and prepare for prosthetics.
(To be continued).
If any of the readers are interested in the information, call and write. I will help with all I can. Be healthy today, tomorrow and forever. With respect and love Valery Viktorovich Yegmenov. 446300, Otradny, st. Sovetskaya, house number 91, apartment number 122. Samara region. Call number 8 – 960 – 826 – 04 – 67. E-mail: [email protected]


Valery Viktorovich Yegmenov Says:
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February 29, 2012 at 12:35 pm

Gangrene, causes and symptoms, treatment of gangrene.

Gangrene (gangrene) is a local death of tissues of a living organism, characterized by the staining of dead tissues in a dark color. Gangrene develops directly or through the anatomical channels. The dark color of the gangrene affected area is associated with iron sulfide, which is formed from hemoglobin when it comes into contact with hydrogen sulfide in the air. The reason for the development of gangrene is the cessation of oxygen supply to the tissues of the body. It can develop in areas remote from the heart (fingers of the extremities), or as a result of circulatory disorders (in the heart or lung with a heart attack).Gangrene is caused by anaerobic bacteria, Escherichia coli, streptococci, aerobacteria, Proteus acteria. Also, gangrene can be in the absence of exposure to microbes (aseptic).
Gangrene is of the following types:
dry or wet
infectious, toxic or allergic
gas, hospital or fulminant
Causes of gangrene
The main causes of gangrene are:
Mechanical or chemical effects. These include injuries that crush tissues and blood vessels, the effects of acids and alkalis on the body.
Physical impact. This includes burns and frostbite.
Cessation of blood circulation. This can be caused by damage to blood vessels, blockage of arterial trunks, vasoconstriction (with atherosclerosis).
At the same time, in all cases, it should be noted that the main reason for the spread of gangrene is not timely measures taken to disinfect the wound and restore blood circulation.
Dry gangrene
Dry gangrene (dry gangrene) occurs when an abrupt cessation of blood flow to the tissues.At the same time, the tissues dry out quickly, bacteria that cause rotting do not have time to penetrate into them.
With dry gangrene, the tissues become dry and wrinkled, they thicken and shrink. This is due to the clotting of proteins and the breakdown of blood cells. The color of the area affected by dry gangrene is black or dark brown. The process that is caused by dry gangrene is also called mummification, since the dried out areas resemble mummy tissue. With the cessation of blood flow to the site, severe pain is observed, the skin becomes pale, then marbled blue and cold.The pulse and sensitivity on the skin in the affected area disappear, but it remains deep in the tissues for a long time, which causes pain.
Dry gangrene spreads from the periphery to the center. After a while, redness or demarcation inflammation occurs at the “junction” of the dead tissue with the living tissue, which subsequently leads to the rejection of the affected area.
Dry gangrene usually results from frostbite (nose, ear tips) or burns.
In case of contact with a putrefactive infection affected by dry gangrene, dry gangrene can turn into wet gangrene.The area affected by dry gangrene is rejected after a few months, and a scar forms in its place.
Wet gangrene
Moist gangrene is caused by the same reasons as dry, the difference is that with wet gangrene the tissues do not have time to dry out and are susceptible to putrefactive changes due to the influence of microorganisms. With wet gangrene, toxins enter the body as a result of decay. The decayed tissues are a good breeding ground for bacteria, which further increases the spread of gangrene.
A patient with wet gangrene has an increase in temperature, as there is an inflammatory process. On the affected area, bubbles form, filled with a dark brown liquid. There is also an unpleasant odor spreading from the lesion. With a normal course of wet gangrene, it can turn into dry.
People with diabetes are more prone to developing wet gangrene, since diabetes damages the blood vessels and, as a consequence, impaired circulation.
Gas gangrene
Gas gangrene (gas gangrene) develops in the tissues of the body in the absence of access to oxygen to them, is an infection. It is caused by bacteria of the genus Clostridia. These types of bacteria live in soil and dust. But mostly they accumulate in areas where there are livestock and other animals (pigs, sheep).
Areas that are susceptible to gas gangrene are wounds that are contaminated with earth, have wound pockets and dead tissue, poor blood supply. When injected into a wound, the causative agent of gas gangrene spreads rapidly, while gas bubbles are released.The gas has an unpleasant sweetish putrid smell. Exotoxins and endotoxins are released, which quickly dissolve tissues.
Approximately 6 hours after infection, the patient’s condition worsens. In this case, the skin around the wound turns pale. The bottom of the wound is dry, the wound itself is very painful, and a crunch is heard when pressed. The visible muscles of the wound look like boiled meat. The state of health sharply worsens, shock may occur.
Symptoms of gas gangrene: Krause symptom.On an X-ray, intermuscular gas accumulations look like Christmas trees.
Melnikov’s symptom. When applying a ligature, after 15-20 minutes, the thread digs into the skin, as the area swells a lot.
Champagne cork symptom. When removing the tampon from the wound, a kind of cotton is observed, reminiscent of the opening of champagne.
Spatula symptom. When tapping on the affected area with a metal spatula, a crunch is heard.
The patient complains of severe pain in the affected area. The swelling of the affected area rapidly increases.The tissues in the area of ​​the wound have a pale, sometimes cyanotic color.
Decubital gangrene
Decubital gangrene (bedsore) affects areas of the body that are close to the bone. It is ischemic necrosis with damage to the skin. Formed by prolonged pressure on a part of the body. It occurs in people who have been in a supine position for a long time, who have a reduced feeling of pain, in weakened people. The following areas are susceptible to decubital gangrene: scapula, sacrum, occiput, thighs, ischial bones.
The development of this disease is facilitated by a decrease in sensitivity and a decrease in the feeling of discomfort in the patient. With prolonged lying position, with poor nutrition and under the influence of various diseases, a problem with blood circulation arises in the body area, which causes the development of gangrene. Exposure to certain places of pressing forces for more than 2-3 hours can lead to the development of a pressure sore, while the sweat released only aggravates the situation, since it contributes to the multiplication of harmful bacteria at the site of compression.
Treatment of gangrene (modern medicine)
Modern medicine as a means of treating gangrene uses such as amputation of the affected area and subsequent treatment with antibiotics to prevent further spread of gangrene. For the prevention of gangrene, it is necessary to take measures as soon as possible to restore the impaired blood circulation in order to prevent necrosis.
Treatment of dry gangrene
When treating dry gangrene, it is necessary to wait for the appearance of the demarcation line, while applying antiseptic dressings and agents that improve blood circulation.After that, the dead tissue is amputated. If dry gangrene is damaged in areas such as the tip of the nose, phalanges of the fingers, earlobes, these areas can be rejected on their own. Then antibiotics are used.
Treatment of wet gangrene
The peculiarities of wet gangrene are that the intoxication of the body quickly sets in, which necessitates early amputation of the affected part of the body. In case of gangrene of the abdominal organs, it is necessary to urgently produce abdominal surgery to remove the affected organs.
Treatment of gas gangrene. At the first signs of gas gangrene, the patient is injected with painkillers, supports cardiac activity, and fights intoxication. In almost all cases of gas gangrene treatment, they resort to the classic method – amputation.
Treatment of gangrene with folk remedies.
Tatarnik with gangrene.
In 3 liters of water, add 1.5 cups of dried tartar greens along with flowers, boil for 5 minutes, leave for 30 minutes. Pass through a sieve. Dilute 1.5 liters of the mixture with water heated to 37 ° C. In the resulting water, you need to keep the area affected by gangrene for 30 minutes, or make lotions.
Black bread with salt.
Thoroughly salt freshly baked black bread, chew it. Apply a thick layer of chewed bread to the affected area, bandaging this place.
Curdled milk.
Make lotions using homemade yogurt, periodically changing it.
Beef liver.
Apply fresh beef liver to the affected area.The liver must not be washed. Keep the liver in the affected area until bubbles with liquid appear under the liver. If bubbles appear, take a sterilized needle and pierce all the abscesses with it. Then attach the liver again. Do this for a long time. You can tie a piece of liver to a sore spot.
Young shoots of needles.
Finely chop the young shoots of the needles. 5 tablespoons of chopped shoots pour 500 ml of water and boil for 10 minutes over low heat. Then pour everything into a thermos and leave for 12 hours.Drink only this infusion as tea every day.
Lily oil for gangrene.
Take 5 stems of lilies with flowers, cut, put in a liter jar and pour over with unrefined oil. Insist in a dark place for 2 weeks. Strain, oil the sore spot, or apply a cloth soaked in this oil. All the best to you and be healthy today, tomorrow and always. With respect and love Valery Viktorovich Yegmenov. Website on the Internet: vaierijjegmenow.narod2.ru


Valery Viktorovich Yegmenov Says:
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February 29, 2012 at 12:44 pm

Valery Yegmenov: Diabetic foot. Gangrene of the foot.
One of the most important topics for people suffering from diabetes mellitus is the diabetic foot and, as a result, the incipient gangrene, which leads to amputation of the limbs. Surgeons do not use folk recipes and remedies for this diagnosis in the treatment. They recommend one-off amputation of the affected area of ​​the leg.It always turns out that way, as soon as you cut off a piece, gangrene immediately affects the next area. That is, the disease is progressing. As a result, a person in a short period of time remains without legs, becomes disabled for the rest of his life. I propose this topic for discussion on the forum. Let us, friends, all together help us with a kind word and advice to the sick. We will share our experience and knowledge. We will tell them how you can OVERCOME THE DISEASE with means and recipes of traditional medicine. Thanks to everyone who will help and respond to my call and take an active part in the discussion on the forum.Be healthy today, tomorrow and forever. Best regards, Valery Yegmenov.
My aunt has gangrene now. It all started with one toe. It was removed. The wound after amputation did not heal for a year. They treated with folk remedies, the doctor suggested amputation of the limb, the aunt refused. The result – a year later, 3 more fingers were removed, the fifth one disappeared by itself. The disease is progressing. The leg has now greatly decreased in size, the nerve endings have died (she does not feel pain on this leg at all). Problems with consciousness began – then everything is fine, then it falls into some other life, does not recognize the children, does not remember relatives.We consulted with a very good endocrinologist, she said that this condition can last for a very long time. And that it would be better to do the amputation on time, now it is too late, the body is badly poisoned and the time has been lost. So you cannot rely on traditional medicine 100%. Here you write that it is worth to amputate a piece, so the disease immediately affects the next area. So this is not entirely true. The disease means it has already struck, the next section, even before the amputation, has simply not yet manifested itself. Be healthy! Natalya: I have been working in an ambulance for about 30 years.I propose a specific treatment for incipient gangrene that will really save you from amputation. The system has been prescribed by experienced vascular surgeons and has been successfully used for many years in the surgical department of the hospital.
Patient should be given droppers for 5 days: reopolyglucin 400.0 with isotonic solution, + trental 5.0 or alternate every other day with solcoseryl 2.0 intramuscularly or in a rubber band with rheopolyglucin. At temperature – with hemodez. On the fingers – bandages with pink or sea buckthorn oil and solcoseryl gel.Further injections – Actovegin 2.0 or 5.0
No. 20 intramuscularly. Every autumn and spring – Actovegin (Solcoseryl) 15-20 injections into the muscle. Tested on friends and family. I wish everyone health, happiness and good luck. I would be happy if it helps anyone.
Nadezhda Lebedeva:
I myself am very worried, because. I also have high sugar. Olga Ehrenburg:
I am also worried about this problem. Yesterday they did a bridle of NK vessels. and it turned out diabetic vascular disease
Hello! In the ambulance, such diseases are not treated and such statistics are not kept.And this method of treatment was taken by our employees in the surgical department of the hospital for personal use. From my environment, I can say about two specific cases. A close friend, having learned that a relative is in a hospital in another city and is being prepared for amputation of her fingers, took all the drugs, went there and insisted the doctors carry out this treatment, and this saved her from amputation. About seven years ago, a similar story happened to my close relative. And thanks to this method, it was possible to save his fingers. Unfortunately, this does not always cure, but helps in the initial stage and for a certain period.Our relative has also been treated again. For examination and consultation, you need to contact an angiosurgeon. That’s all I can say. I wish you health and success.
Valery Viktorovich Yegmenov: At the beginning, hello, Natalia! Thank you VERY MUCH, FROM ALL YOUR SOUL for your kind and warm words, wise advice and timely recommendations, stories. Thank you. I took note of everything. I think that those who are sick and read our repetition did the same. Thank you again. You are so kind … it is immediately evident that the health worker is experienced, competent, capable of responding to other people’s pain and misfortune.Be happy today, tomorrow and forever. Elena Kurchatova:
My mother has diabetes mellitus and she is insulin dependent. I will not tell you the recipe, but I can share the following – you can apply a bandage with insulin solution to small wounds.
Natalia, thanks for your system!
Ksenia Likhanskaya:
Contact vascular surgeons. In most cases, at an early stage of the disease, everything is fixable. Even in advanced cases, there are doctors who undertake microsurgery to restore the affected limbs.Come to them on time. Make it easy for them and help yourself.
Valery Viktorovich Yegmenov:
Hello! Ksenia, could you tell all of us where you can find such surgeons? I personally know only those who have a great desire to cut everything off, and believes that they have completed their task. I have not met anyone else yet. Thank you. All the best. Ksenia Likhanskaya:
With great pleasure.
My grandmother was operated on by Igor Mikhailovich Kalitko, a vascular surgeon. He is the head of the Medical Vascular Center in St.Zelenograd. Now his address is not at hand, but I am sure any search engine will give his data. Hospital and operating rooms in Klin, Moscow Region. He performed a complex operation for my grandmother to revascularize the foot. For a total of 9 hours, he sewed new vessels for her under a microscope. This is a wonderful doctor, golden hands, while young – he takes on everything … Of course, the center is commercial, but this person will never take too much from the elderly, he has a special approach to pensioners. But I don’t mind any money for his hands.His approach is to do everything possible and impossible and only then amputate something … Now the whole family is watching his legs and arms. Angio-surgeon is a doctor for life, it is worth visiting him once.

November 24, 2010 at 02:18 (link)
Valery Viktorovich Yegmenov:
Ksenia, thank you for the letter. An address is found, tell us all of it. I think that many patients will need it and the sick will take advantage of it. Honor and praise to such doctors! Thanks. All the best to him and to you personally.Write. We wait. Bye. Ksenia Likhanskaya:
In case of bruises, abscesses on the legs, ordinary cabbage will very well help, Wrap a leg of cabbage with a leaf, put it on its sock and hold it for a day (the leaf will turn into a thin piece of paper). Change to fresh. It dissolves gimotomes very well.

November 24, 2010 at 01:51 (link)
Valery Viktorovich Yegmenov:
Ekaterina, hello! Yes, indeed, your recipe works and helps with hematomas. But, not with a diabetic foot. You cannot cure gangrene with a cabbage leaf.Happy 2011 to you. Thank you and health to you, kind-hearted man! Lyudmila Mukhanova:
Hello, I’m 56 years old, type 2 diabetes, I’m on pills. One of the relatives died at the age of 54, after the amputation of both legs. At the dacha, I injured my finger after a short treatment, amputated, diagnosed with diabetes mellitus, then amputated a leg to the knee, then above, then the second leg, all this in Moscow for 2 years. A healthy strong man without bad habits. Let’s help and learn from each other.Thanks.

November 25, 2010 at 02:02 (link)
Valery Viktorovich Yegmenov:
Hello, Lyudmila! Thank you for your letter. I sympathize and worry. I completely agree with you that we need to help each other. This is the purpose of my life. Yesterday I made a bandage on my left foot … blood spurts in a stream. A little later I will give here a description of folk methods of treatment, recipes for patients. Check back often and you will find out soon. In the meantime, I wish you health today, tomorrow and always and … Natalia:
Hello, Valery! Thank you for your kind words and wishes.And you, if your blood is already gushing, you need to go to the hospital right now, insist on such treatment and it will definitely help you, heal your wounds. My husband has type 2 diabetes, I am very worried about him, so this topic worries me very much. I strongly advise all patients who have such a problem to take note of our method of treatment. It is very powerful indeed. I would be very glad if it helps someone. I wish you all health, happiness, good luck!
Valery Viktorovich Yegmenov:
Problems with gangrene are well solved in Khakassia by the folk healer Praskovya Yakovlevna Losevskaya, as well as in the branches of the Praskovya phytocenter in many cities of RUSSIA. It is more convenient for residents of Yekaterinburg to contact the health-improving phytocenter “Praskovya”, which is located at Uralmash on ave.Ordzhonikidze 12, and residents of other regions should, protect: http://www.praskovia.ru E-mail: [email protected]
Valery Viktorovich Yegmenov:
Alexander Barkovsky. Hello! Please accept my sincere words of gratitude for participating in the forum and for your advice and recommendations. Hundreds of thousands of people will also be grateful for your help. Why? All our correspondence and the best advice, recommendations, folk recipes and methods of treating diabetic foot, incipient gangrene, I send to the best newspapers: “Curative mail”, “Sick question”, “Old doctor”.This is where all the material will be printed. Why did you do it? Many patients and their relatives do not have computers or Internet connectivity. And these newspapers are available to everyone. They can be bought at all Soyuzpechat kiosks in Russia, the CIS, abroad in the USA, Greece, etc. Let people familiarize themselves with your advice and decide how to treat it. I hope that all the participants in this forum will support me and not condemn me for my decision. And further. I ask all of you who read and write everything about this disease on the forum to tell about us to all your friends, relatives and friends, everyone you know.We need to give people more information and connect them to work on this page. Will you be so kind. Help people. Good will certainly return to you all. I hope and count on your help, support, understanding. From the bottom of my heart THANKS TO YOU ALL, GOOD PEOPLE. Valery Viktorovich Yegmenov:
Friends, write down the addresses and phone numbers of INNOVATIVE VASCULAR CENTERS – INMoscow: Mitinskaya street, 12, (metro Volokolamskoe), phone number 8 (495) 649-05-73. In Zelenograd: Moscow, Zelenograd administrative district, building 1639, (station Kryukovo, Oktyabrskaya railway) telephone number 8 (495) 649-05-73. In St. Petersburg: 4th Krasnoarmeyskaya street, telephone number 8 (812) 649-05-73. All these Innovation Centers are engaged in the treatment of gangrene of any stage in diabetic foot and not only. Services and treatment, recovery after operations are paid. If any of you is interested in information and additional recommendations are needed, please leave your wishes and questions here on the page.I read all of them all the time and will give you the answers. All the best! Be healthy today, tomorrow and always!

Gas gangrene ›Diseases› DoctorPiter.ru

Despite the fact that antibiotics are readily available today, and the latest means are used in operating rooms to ensure asepsis, it has not yet been possible to get rid of gangrene. Gas gangrene is an infection caused by anaerobic bacteria of the genus Clostridium. These microorganisms do not need oxygen and enter the human body through wounds.Gas gangrene most often affects the limbs – arms and legs, but the abdomen and even the uterus may also be affected.


Gas gangrene develops very quickly. A person suffering from gangrene usually has a decrease in blood pressure, tachycardia, fever (up to 38-39 °), rapid breathing, dehydration, insomnia, depression or, on the contrary, severe agitation, anemia. There are also local symptoms – severe pain in the wound, swelling around it, discoloration of the skin around the wound, blisters.After a while, areas of necrosis, cadaveric odor, blood clots appear. There are 4 forms of the disease:

  1. Classic gas gangrene. With this form, the tissue in the area of ​​damage swells, gradually becomes dead. The whole process is accompanied by intense gas formation. The skin around the wound is pale, with brown spots, no pus. After a few hours, the damaged tissues turn gray-green and acquire a cadaverous odor.
  2. Edematous toxic form.This form is accompanied by edema, which quickly spreads to healthy tissues. Gas formation in the edematous-toxic form is weak, there is no pus. Muscle necrosis begins almost immediately after injury.
  3. Phlegmous form. The symptoms of gangrene in this case are mild. With this form, a small area is affected, there is no edema, there are no spots on the skin, but the process is accompanied by the release of pus and strong gas formation.
  4. The putrefactive form develops very quickly.The process is accompanied by violent gas formation and the release of pus. This form of gangrene is most often localized in the mediastinum and rectum. The rapid development of gangrene in this case occurs due to the symbiosis of aerobic and putrefactive bacteria. At the same time, putrefactive bacteria release a toxin that destroys proteins of tissues and walls of blood vessels. Because of this, bleeding is characteristic of the putrefactive form of gangrene.

There are also specific symptoms:

  • Krause’s symptom – gas accumulations on the X-ray are arranged in the form of Christmas trees
  • Melnikov’s symptom – the affected area swells so much that within 15-20 minutes after the ligature is applied, the thread very strongly digs into the skin.
  • A symptom of a spatula – when tapping on the affected area with a metal spatula, a crunching sound is heard.
  • A symptom of a champagne cork – when you pull out a cotton swab from a wound, you can hear a soft pop, reminiscent of opening a bottle of champagne.


Clostridium perfringens bacteria, Cl. septicum, Cl. oedematiens and Cl. Histolitycum is normally present in the intestines and genitourinary system of humans.In addition, they live in the soil. These microorganisms get into wounds during operations and as a result of injuries. They feed on dead tissue in the wound, and release toxins and gas during their life.

Favorable conditions for the development of gangrene – lacerated, lacerated-bruised, gunshot wounds, contaminated with earth, pieces of tissue. The more the muscles are destroyed, the better the clostridia take root in the wound. But not so much depends on the size; even a very small wound can be complicated by an anaerobic infection.

Symptoms develop approximately 6 hours after infection. A person’s condition deteriorates sharply, so much so that shock may occur. Affected muscles resemble boiled meat and exude a sweetish putrid smell.


The diagnosis is made on the basis of the characteristic clinical presentation of the wound. You also need to consider whether the patient has had surgery in the recent past. A blood test shows the presence of an infection, an x-ray shows the presence of gas in the wound, a microscopic analysis of the discharge from the wound shows the presence of clostridia.

Differential diagnosis is carried out with fascial gas-forming phlegmon, in which, unlike gangrene, muscles are not affected.


At the slightest suspicion of gangrene, you should consult a doctor. The doctor will open the wound, excise the dead tissue, install a drain to drain the purulent contents of the wound. Antibiotic therapy is also needed. But often, if there is a confirmed diagnosis of gas gangrene, the patient’s life can be saved only by amputating the affected limb.In this case, the wound after amputation cannot be sutured. After the operation, the patient is prescribed hyperbaric oxygenation (a physiotherapeutic method of treatment in which the patient is placed in a pressure chamber, where he breathes in oxygen under pressure).

If treatment is started late, the disease is fatal within 2-3 days. Although there is also instant gas gangrene, as a result of which death occurs faster. In this case, only immediate surgical intervention can save lives.


Prevention of gas gangrene consists in timely surgical care and careful treatment of wounds.

Gas gangrene sufferers should be isolated and a separate nursing post should be set up for them. All linen and tools must be thoroughly sterilized. The medical staff of the department must observe personal hygiene, all procedures must be carried out with rubber gloves.

© Dr. Peter

Diabetes mellitus in questions and answers

Diabetes mellitus is a disease caused by a complete or relative lack of insulin (a hormone of the pancreas), as a result of which the blood sugar level rises and energy metabolism disorders occur, sometimes very significant.

Diabetes mellitus is a group of diseases that manifest themselves in a similar way, but have different causes. Type 1 diabetes mellitus occurs in childhood or young age, proceeds violently, is characterized by a strong feeling of thirst, carries the danger of a significant violation of energy metabolism, is treated with insulin. Type 2 diabetes mellitus is more common in old age, is often accompanied by obesity, its symptoms are not as obvious as in type 1 diabetes, treatment can be started with diet or taking antidiabetic drugs – in the form of pills.Diabetes mellitus can also be caused by other diseases (the so-called specific types of diabetes), for example, diseases of the pancreas, it can be caused by treatment with corticosteroids.

How is diabetes mellitus manifested?

It is manifested by fatigue, thirst, excretion of large amounts of urine, weight loss, inflammation of the bladder and kidneys, and furunculosis can be observed. If diabetes is not treated for a long time, it can lead to a complete disruption of the basic functions of the human body, dehydration, loss of consciousness and even death.Type 1 diabetes mellitus is characterized by a sharp manifestation and development of all symptoms of the disease. Type 2 diabetes mellitus develops more slowly, its symptoms are less pronounced, they may not appear outwardly at all until late complications of diabetes appear.

Can diabetes mellitus go on without symptoms?

Diabetes mellitus type 2 at the onset of the disease often does not appear at all and can be detected during a routine examination by an increase in blood glucose and the appearance of sugar in urine.

Is diabetes mellitus hereditary?

Yes, both types of diabetes mellitus, especially type 2 diabetes, can be inherited in a certain way, more precisely, a predisposition to this disease is transmitted, and it depends on external influences whether a particular person will develop diabetes or not.

Can drugs or other diseases cause diabetes?

This type of diabetes is called secondary diabetes mellitus (or specific type of diabetes).The development of this diabetes can be triggered by certain medications, such as corticosteroids used in the treatment of rheumatic diseases, asthma, a number of non-specific intestinal diseases, skin diseases and other autoimmune diseases. Diabetes mellitus can appear as a symptom of a pancreatic disease, with some endocrine diseases, severe infectious diseases. Some diseases, more often of a viral nature, prolonged stress can provoke diabetes or a worsening of the course of existing diabetes.

What is impaired glucose tolerance?

Previously, this condition was called “latent” (dormant, asymptomatic) diabetes mellitus. It is found only in laboratory analysis, with the so-called glucose tolerance test, when the patient drinks a glucose solution (75 g in 100 ml of water) and the level of glucose in the blood after 2 hours reveals how fully his body is able to assimilate this glucose. This test shows the ability of the pancreas to produce the required amount of insulin per meal.In case of violation of glucose tolerance, medical supervision, adherence to a diet, and sufficient physical activity are necessary.

When is diabetes mellitus diagnosed?

If the patient has symptoms typical of diabetes mellitus (thirst, urinary excretion, weight loss), a blood sugar test is sufficient. If its level in capillary blood on an empty stomach is more than 6.1 mmol / l (two-fold definition), it is diabetes mellitus. If the patient does not have symptoms typical of diabetes, but there is only a suspicion of diabetes mellitus, a glucose tolerance test is performed, the principle of which is described above.According to the body’s reaction to this load (the glycemic level after 2 hours is more than 11.1 mmol / l), it is determined whether it is really about diabetes mellitus or only about impaired glucose tolerance (the level of glycemia after 2 hours is more than 7.8 mmol / l) …

Is it possible to plan a pregnancy with a diagnosis of diabetes mellitus?

Yes. However, before pregnancy (about 1 year) and throughout pregnancy, it is necessary to strictly control the compensation of the disease and adequately treat diabetes.During pregnancy, insulin must be administered, tablets are not used so as not to harm the fetus and not endanger its life. To assess the compensation of the disease, it is necessary to control the level of glycated hemoglobin once every 3 months.

Can I go in for sports, work with diabetes mellitus?

With diabetes mellitus, you can go in for sports, do physical work. Physical education and increased physical activity are usually desirable.This increases the sensitivity of the tissues to insulin and helps maintain an optimal weight. With heavy loads, it is necessary to consult a doctor, prescribe a diet and doses of insulin or antihyperglycemic drugs, taking into account the load so as not to cause hypoglycemia (a strong decrease in sugar levels). With regard to work, the patient should choose a type of activity with the ability to maintain a correct diet, with uniform physical activity throughout the week. For patients with diabetes and the danger of hypoglycemia, professions where the patient could harm himself or others are unsuitable – work at heights, associated with high voltage currents, driving a car, construction machines, etc.p.

How is diabetes treated?

The main task of treatment is to achieve a normal blood sugar level and maintain this level throughout life. This is necessary to prevent complications of diabetes mellitus. Treatment is based on changing the optimal exercise and diet. It is necessary to achieve weight loss in excess of it. If physical activity and diet are not enough to achieve normal sugar levels, antidiabetic drugs (pills or insulin) must be added.In type 1 diabetes, insulin treatment is necessary from the beginning of the diagnosis, as it is associated with primary damage to the cells of the pancreas.

What should be the diet for diabetes?

Diabetes diet is not only about eliminating sugar, sweets and sugary foods from food. Each patient should have an individually designed diet with a certain amount of carbohydrates, fats, proteins and calories so that blood sugar levels are normal, fat metabolism is not disturbed, the patient has an ideal weight and maintains it.Simple sugars should be eliminated from the diet, which are quickly absorbed, causing a sharp rise in blood sugar. The total amount of carbohydrates should be 55-60%, with a predominance of coarse fiber, fats – 25-30% (with a predominance of vegetable fats), proteins – 15-20%.

Do I need to follow a diet if I take pills or insulin?

Yes, it is necessary! A diet (good nutrition) is necessary for every patient, even if he must take pills or insulin.

What if I don’t follow the diet?

If the diet is not followed, there is a danger of poor compensation with the risk of complications. If you do not follow a diet and increase the dose of drugs or insulin doses, the patient may gain weight, worsen the sensitivity of cells to insulin, and treat diabetes will fall into a vicious circle. The only way to avoid these complications is to adjust your diet in such a way as to normalize and maintain weight.

Why can some patients take pills while others need insulin right away?

It depends on the type of diabetes.In patients with type 1 diabetes, the pancreas does not produce insulin and therefore insulin must be used from the onset of the disease. In patients with type 2 diabetes, the lack of insulin is only relative, often at the initial stage of the disease, it is enough to follow a diet and take medications that improve the body’s sensitivity to insulin or increase its secretion by the cells of the pancreas. If pill treatment stops working, insulin should be started.

How many times a day do you need to “inject” insulin?

When treating diabetes, we strive to match blood sugar levels with those of healthy people.Various insulin delivery regimens are used, which depend on the type of diabetes and the course of the disease. Often in young patients

Cardiovascular surgeon, phlebologist – Medical Center Sofia, Anapa

Medical Center “Sofia” is a modern clinic in Anapa!

Cardiovascular surgeon, phlebologist

Vascular surgery (angiosurgery) is a field of medical science, a separate part of surgery that studies blood and lymph vessels.Angiology is a science that studies the causes of vascular diseases, pathogenesis, clinical picture. Angiology also includes the study of preventive and therapeutic methods for the healing of human blood vessels. The very word “angiology” comes from two Greek words: angio – vessel, and logia – science. From here, you can get a clear understanding of the essence of angiology – the science of blood vessels.

There are two types of blood vessels: arteries and veins.

Arteries – vessels carrying blood from the heart, enriched with oxygen and nutrients to the tissues and organs of the body.The main artery of the body is the aorta, which leaves the left ventricle of the heart and passes from the chest cavity to the abdominal cavity, giving off many branches to all tissues and organs of a person. Each branch eventually passes into the capillaries, at the level of which the blood supply to the tissues occurs. Veins originate from the capillaries.

Veins – vessels that ensure the outflow of blood, poor in oxygen and nutrients and rich in carbon dioxide, from tissues and organs to the heart. From the upper and lower half of the body originate, respectively, the upper and lower hollow veins, which flow into the right atrium, on which the Big Circle of Blood Circulation ends.The Lesser Circulation is represented by the pulmonary trunk leaving the right ventricle of the heart, carrying blood to the lungs, where it is enriched with oxygen and, with the help of the pulmonary veins, returns to the left atrium. Then the blood flows back into the Big Circle of Blood Circulation. There are many diseases that affect arteries or veins. They are congenital and acquired.

congenital include various diseases in the form of excessive vasoconstriction, pathological tortuosity of the arteries, insufficiency or absence of vein valves, etc.

K acquired – atherosclerosis, nonspecific aorto-arteritis, thromboangiitis obliterans, varicose veins of the lower extremities and small pelvis, thrombosis of arteries and veins of various origins, etc.

Atherosclerosis and other obliterating diseases lead to a gradual narrowing of the arteries, up to its complete blockage. These processes manifest themselves in the form of pain, mainly in the lower extremities, which leads to intermittent claudication, and subsequently to pain at rest.And, in the end, in the absence of treatment, everything ends with the discovery of a seriously curable trophic ulcer or gangrene.

Varicose veins affects the veins of the lower extremities. It manifests itself as a local or widespread expansion of the saphenous veins. Dilated veins are a reservoir for the formation of blood clots and the development of thrombophlebitis. In the chronic course, varicose veins lead to the appearance of areas of hyperpigmentation (areas of local darkening of the skin) and, finally, a long-term non-healing trophic ulcer is formed

The main symptoms that you should contact a vascular surgeon:

  • Pain in the lower extremities when walking
  • Recurrent headaches, dizziness
  • Condition after a stroke
  • The presence of pulsating formations in the extremities
  • Pain, sensation of a pulsating formation in the abdomen
  • Feeling of coldness in the fingers of the extremities
  • Heaviness in the lower extremities, periodic swelling by the end of the day
  • Varicose veins of the lower extremities
  • The presence of telangiectasias, spider veins
  • The presence of a sudden dense edema of the lower or upper limb
  • The appearance of sudden sharp pains in the limbs against the background of complete well-being
  • 90 033 The presence of trophic disorders of the lower extremities.

All modern methods of diagnostics and treatment of vascular diseases are carried out at the Sofia Medical Center. Here you can get advice from an angiosurgeon, appropriate conservative and surgical treatment.

Diagnostic capabilities, including ultrasound triplex scanning of arteries and veins of any location, CT angiography, etc., allow you to make the most accurate diagnosis, according to which the required treatment method is selected.

The operating unit of the clinic is equipped with equipment that enables operations on the vessels of the lower extremities, brachiocephalic arteries, abdominal aorta, modern treatment of varicose veins, ranging from reticular varicose veins to trophic ulcers.

Timely referral to a vascular surgeon minimizes the risk of complications and trophic disorders.

Balanoposthitis in men: treatment, surgery (PHOTO)

How to treat balanoposthitis at home?

Treatment of balanoposthitis, as a rule, takes place at home, i.e. outpatient. The doctor prescribes a treatment regimen, the patient, adhering to it, completes the course and takes control tests.

If we are talking about self-medication and “folk” methods, then we, as representatives of scientific medicine, are bad helpers here, and in this case the patient takes full responsibility for his own treatment.Self-medication of balanoposthitis can lead to chronic inflammation and even greater complications: phimosis and paraphimosis with infringement of the glans penis, ascending infection with the development of cystitis and pyelonephritis, decreased sensitivity of the glans penis, the appearance of malignant neoplasms and processes.

Menshchikov Konstantin Anatolyevich does not recommend self-medication.

Which doctor treats balanoposthitis? Urologist or andrologist, dermatovenerologic.Technically, diseases of the skin of the head of the penis or foreskin are skin diseases, so do not be surprised if you are referred to a dermatovenerologist.

How long is balanoposthitis treated? Timing depends on the form and pathogen. A simple bacterial inflammatory process in an acute form will disappear in a week. Candidiasis may not go away for a month if it has arisen against the background of serious immunity problems. Sometimes, for a successful cure, it is required to eliminate the cause of the accumulation of secretions under the foreskin and to perform circumcision or plastic surgery of the frenum.In addition, the longer a man pulls to visit a doctor, the stronger the chronicity of the inflammatory process is.

Is it contagious? Can I transmit the disease to my partner?

The infectivity depends on the nature of the inflammation. Infectious balanoposthitis is highly contagious. But even in the case of non-infectious balanoposthitis, if there is redness, itching, pain and burning during urination and other symptoms, you should refrain from sexual activity and undergo treatment.

What is the most effective remedy (medicine) for balanoposthitis? This question can only be answered by knowing the exact pathogen.Creams and ointments are adjuncts. Antibacterial drugs are often needed.

IMPORTANT! There are many steroid hormone-based ointments that quickly relieve unpleasant symptoms. Their use for more than the prescribed period leads to serious complications. Strictly follow your doctor’s prescription.

Is antibiotic treatment effective? With a purulent form of bacterial balanoposthitis, this is the main way to get rid of the problem, and antibiotics are prescribed not locally, but in tablets.With fungal or allergic inflammation, this approach will only exacerbate unpleasant symptoms. Therefore, it is so important to decide on the choice of a medicine based on the test results.

The doctor said that I needed to be circumcised, but I read that it is possible to cure balanoposthitis with ointments and pills.

Balanoposthitis in a chronic form and with recurrent cases of inflammation is really not amenable to therapeutic treatment. Those. each time it is more and more difficult to stop the inflammation.In addition, the doctor cannot prevent the recurrence of balanoposthitis. Circumcision is indeed recommended by the Ministry of Health of the Russian Federation and the Associations of Urologists as a preventive measure against phimosis, paraphimosis, balanoposthitis, balanitis and penile cancer. If in doubt about the appointment of your doctor, contact another specialist for a second opinion.

Balanoposthitis does not go away. What to do?

If this is the first case of balanoposthitis in your life, then the pathogen may be incorrectly identified, which means that the treatment is incorrectly selected.If we are talking about a chronic disease, then it really becomes more difficult to defeat inflammation from time to time.

90,000 Gout treatment in Germany: how is gout treated in German clinics? | Gout – treatment in Germany

Gout is a chronic joint disease. It is accompanied by damage to the kidneys and joints, due to the deposition of uric acid salts and is directly related to metabolic disorders. This disease has been known since ancient times, otherwise it is called “the disease of kings.”With this disease, human uric acid is deposited in the form of crystals in the joints, respectively, their work is disrupted. They are either in the form of diamonds, or in the form of a rhombic plate. Statistics and medical practice show that the male sex most often suffers from the disease. At the initial stage, the disease is paroxysmal, about two or three times during the year. Today, gout is considered a rare disease, it affects three out of 1000 people. It can develop as an independent disease (primary), and against the background of some blood diseases (secondary).It is also worth noting that gout is often accompanied by obesity, diabetes mellitus, and hypertension. If you do not start therapy on time, this can lead to deformation of the joint, and according to statistics, almost 20 percent of people with gout develop kidney stones.


Attacks of acute gout usually occur suddenly. Their development can be influenced by recent trauma, surgery, drinking large amounts of alcohol, protein foods, fatigue or overwork, stress.Most often, sudden severe pain occurs in one or several joints at once at night. When you touch the skin above the joint, unbearable pain is immediately felt. The joint begins to swell, the skin immediately turns red, and when pulled, it becomes shiny and warm to the touch. Also, the symptoms of gout can be expressed in fever, chills, increased heart rate, or your general condition worsens significantly and you feel unwell. In most cases, the disease affects the joints of the big toes and affects the joints of the instep, knee, wrist, or elbows.Crystallization occurs precisely in these places due to the fact that these places have a lower temperature, in the central part it is higher. Indeed, it is at low temperatures that urates crystallize. Crystals also form in “cold” places such as the ears. In rare cases, gout can affect the spine, shoulders, or hips .;

Diagnosis of gout in Germany

When the first signs of gouty arthritis appear, a competent rheumatologist of our medical center will immediately prescribe an X-ray of the hands and feet to the patient, as well as a biochemical blood test.When examining X-rays, the doctor, with his sharp eyes, will instantly detect characteristic gouty “punctures” in the periarticular bones. And with the help of a blood test, we find out if the level of uric acid is elevated. If the lesion is pronounced, and the presence of “punctures” in the bones is found, in this case the diagnosis is reliable. Most often, patients come to us at the time of an attack, but the fact is that, just at these moments, the analysis for uric acid may turn out to be absolutely normal and will not fix problematic data.Inexperienced doctors may give you a completely different diagnosis, for example, gangrene, if gout manifests itself on the toes. Improper diagnosis and treatment can lead to amputation of the inflamed toe, but after a couple of months or even weeks, it may appear on your other leg. Therefore, diagnostics should be done in Germany, we will never subject our patients to wrong diagnosis, and subsequently, to wrong treatment.

How gout is treated in Germany

First, in order to begin a complete treatment, it is necessary to reduce pain by suppressing inflammation.Secondly, in order to cure gout, you need to exclude factors that can develop, exacerbate the disease. Most often, treatment in Germany involves not only the use of “cool” miracle drugs, but also the exclusion of certain products, for example, meat, mushrooms, salt, broths, mackerel, liver, and alcohol. To treat acute and chronic gout, our rheumatologists prefer and recommend in a comprehensive manner. This is what will help restore the balance of metabolic processes in the body and improve kidney function. Comprehensive treatment can help relieve symptoms, stop disease progression, and improve quality of life.Since it is largely associated with impaired metabolism in the body, treatment in Germany provides an individual diet for each patient. The gout diet usually includes the use of fruit juices, steamed vegetables, and fried meat, replaced by boiled meat. For each patient, there is an individual list of products that are excluded from use. Therefore, in order to eliminate the initial cause of the disease, it is necessary to consult a specialized doctor, based on the characteristics of your body, a treatment and a diet will be drawn up that will contribute to a speedy recovery.

Participation of related doctors

Based on what has been written, we can conclude that the disease is quite complex. It can often resemble other diseases. If you draw the wrong conclusions, you can not only not cure the disease, you can exacerbate it, or even worse, prescribe the wrong treatment. Our medical center does not tolerate mistakes. Therefore, we practice the participation of related doctors. We fully trust our specialists and are confident that they will not let us down, but the health of our patients comes first.Therefore, if doubts arise, or the diagnosis is controversial, our doctors are always ready to help each other.