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Gangrene: symptoms, causes, treatment of gangrene of the lower extremities

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The co-author of this article is Chris M. Matsko, MD. Dr. Matsko is a former doctor from Pennsylvania. He graduated from Temple University Medical School in 2007.

The number of sources used in this article is 13. You will find a list of them at the bottom of the page.

Gangrene is a serious disease that requires immediate professional medical treatment. The longer you wait, the less likely you will be to recover completely. Doctors often treat gangrene by removing dead tissue resulting from the disease, administering antibiotics, and using various treatment methods, including oxygen therapy and larvae treatment. Learn how gangrene is treated to know what to expect.

Classification

Depending on the type of tissue damage, it is customary to distinguish four types of gangrene:

  • Dry is the most favorable form of the disease, in which the process does not extend to the surrounding tissues, but remains within the affected part (finger, lower leg, forearm, etc.). In this case, the organ has the characteristic appearance of “mummified” - it is dense, devoid of moisture, somewhat wrinkled,
  • Wet - a type of gangrene with pronounced processes of decay. The affected area softens, swells due to edema and acquires a putrefactive smell,
  • Gas (a synonym for anaerobic / airless infection) - despite the fact that it is a type of wet gangrene, it is isolated in a separate form. It develops only in the presence of certain microbes (clostridia). It is the most life-threatening patient, as it quickly spreads to healthy tissues and causes severe intoxication (poisoning by toxins) of the body,
  • Pressure ulcer - gangrene of soft tissues (subcutaneous tissue and the skin itself), developing due to constant pressure on one area. As a rule, it occurs in patients who do not change the position of the body several times a day.

In children with insufficient immunity (after infection, against the background of another disease, with congenital HIV), the fifth type of gangrene - “noma” - is distinguished. This is a form of wet gangrene, in which necrosis of the facial tissues occurs: lips, cheeks, gums, fatty tissue. As a rule, it is fatal.

Each type of this pathology has its own causes. Knowing them, you can prevent the development or suspect the disease in a timely manner.

Contrary to popular belief, gangrene can occur not only after gunshot wounds or other limb injuries. It can also be observed during obstruction ("blockage") by blood clots or plaques of various vessels, damage to the nerves of the extremities, the outcome of some infections, etc. Having determined the cause in time, one can assume the form of the disease and choose the optimal treatment.

There is only one reason - the presence of a sufficiently deep wound that was infected with clostridia (bacteria living in an airless space).

However, for the development of gas gangrene, a number of conditions are necessary:

  • The wound should reach the muscles or fatty tissue,
  • Poor blood supply to infected tissues, since clostridia can multiply and grow only in an environment without air,
  • Closing the wound promotes the spread of germs, as the flow of oxygen into the wound cavity decreases.
ViewMost common causesWhich organs are more often affected?
Dry
  • Atherosclerosis is the formation of a blood clot on the wall of an artery that completely closes it.
    • Dry gangrene of the lower extremities most often occurs with thrombosis of the popliteal or femoral arteries.
    • Damage to the hands, as a rule, is due to thrombosis of the brachial artery.
  • Vibration disease is a professional pathology of people who are constantly in contact with vibration (working with jackhammers, concrete mixers, pavers, embossing). Gangrene develops due to a constant spasm of blood vessels that nourish the nerves of the limbs and malnutrition of tissues.
  • Raynaud's disease - the destruction of blood vessels or nerves that provide the work of the final departments of the arms / legs,
  • Polyneuropathy - a violation of the innervation of the limbs, in which the hands and feet are affected,
  • Typhus - in some cases, this infection can lead to dry gangrene of the skin. Most often, the lateral parts of the body are affected.
  • Any parts of the limbs (finger, hand, foot, lower leg, etc.),
  • Leather.
Wet
  • Diabetic foot - gangrene with diabetes most often occurs on the foot or fingers. This is due to a severe violation of the blood supply to these tissues and reduced immunity. Due to these factors, putrefactive microbes quickly attach to a damaged limb,
  • Deep burns (stages IIIb, IV) and frostbite (stages III and IV),
  • Infringement of hernias (can lead to gangrene of the intestinal area),
  • Appendicitis and cholecystitis, which were not operated on in a timely manner,
  • Thrombosis of arteries that feed the intestines (mesenteric),
  • Pneumonia caused by atypical microbes (Clostridia, Bacteroids, Pseudomonas aeruginosa) in patients with immune deficiency can lead to lung gangrene.
Internal organs:

  • Lungs,
  • Intestine (often appendix),
  • Gall bladder.

Extremities (most often feet).

Gas (synonyms - anaerobic, airless or gas infection) Muscles, subcutaneous tissue and skin anywhere in the body. As a rule, the disease begins to spread from the arms or legs.
Pressure soreFor the development of a complete bedsore, 60-70 hours of pressure on the tissue are enough. A great danger of its formation is patients with the following pathologies:

  • Cardiogenic shock
  • Severe hepatic / renal failure,
  • Malignant tumor.
Soft tissue in the sacrum, spine, hip joints, shoulder blades.
NomaThis form of gangrene develops mainly in children weakened by infection. As a rule, these are measles, meningitis or rubella.Tissues of cheeks, lips, gums and deep cellular spaces of the face.

When making a diagnosis, the symptoms of gangrene that the patient complains should also be taken into account. They are determined by the form of the disease and help to navigate during the initial diagnosis.

Depending on the type of gangrene, local symptoms (changes in the limb) or signs of intoxication (temperature, weakness, impaired consciousness, etc.) may predominate. The ability of various forms to spread to surrounding tissues is also significantly different. These points must be considered when choosing a treatment and its speed, as in some cases, a delay of several hours can lead to death.

Gangrene Treatment

Gangrene is the complete necrosis (death) of living tissues that spreads to part of an organ or to a specific part of the body (most often the limb). Pathology can affect the skin, muscles, limbs. It develops when toxins get on the skin, circulatory disorders, excessive temperature, allergic reactions and hormonal disorders, such as diabetes. Treatment of gangrene is aimed at restoring the functionality of healthy tissues adjacent to the affected area and immediately excising the limbs prone to necrosis. But there are more advanced techniques that have high efficiency.

Symptoms of Dry Gangrene

Since this form develops due to malnutrition of the arm or leg, first of all, there are signs of circulatory failure. These include:

  • Feelings of “crawling creeps”, “tingling” in the affected limb or part thereof (fingers, foot / hand, forearm / lower leg, etc.). Perhaps the appearance of pains of an acute nature, which somewhat weaken at rest,
  • Weakness in the limb. As a rule, it manifests itself under load (a long walk, run, climbing stairs - for the legs, wrist grip, carrying heavy objects - for the hands),
  • Pallor and cooling of the area of ​​the skin where there is a lack of flow of arterial blood,
  • Gangrene of the lower extremities is often preceded by "intermittent" claudication.

How to determine the lack of blood supply? To do this, it is enough to know a few simple techniques for limbs:

  • Raise your arms above your head and bend your hands alternately. If the patency of the arteries is impaired, pallor and weakness in the limbs, a feeling of “crawling creeps” and pain
  • Lying on your back, raise straight legs at an angle of 40-45 about. Similar symptoms will appear. Also, the patient can not hold the limbs in this position for longer than 20-25 seconds. Thus, it is possible to suspect the initial stage of gangrene of the lower extremities or the possibility of its development.

These are the easiest ways to assess the condition of the arteries. They are not accurate enough, however, they can determine the lack of blood supply, even at home.

With a complete blockage of the artery, these symptoms are quickly replaced by signs of necrosis (necrosis). The limb acquires a characteristic appearance, which allows you to make a diagnosis of "dry gangrene." Most often, the following changes are noted:

  1. Blackening of tissues - you should pay attention to color, since other forms of the disease are characterized by cyanotic or earthy-green color (exception - noma),
  2. Reducing the size of a limb with gangrene. This symptom is easily detected by measuring arms or legs in symmetrical parts,
  3. Severe dryness in the affected area and lack of perspiration,
  4. Tissues become very dense due to fluid loss,
  5. The growth of hair and nails in the dead part stops.

The patient does not feel pain, since nerve endings die with dry gangrene along with other tissues. Symptoms of a general nature (temperature, dizziness, loss / decrease in appetite, nausea, etc.) are not pronounced, since the body prevents toxins from entering the bloodstream and the spread of the disease. Due to this, the boundary between a healthy and damaged area can be traced very clearly.

In rare cases, a section of dry gangrene can independently separate from the limb, which is equivalent to the patient's recovery. However, you should not count on this outcome and wait for the separation of the pathological focus. If you find the first symptoms, you should immediately consult a doctor who will determine the optimal tactics.

Wave genetics technique

The regenerative matrix ZhKIM allows you to reanimate already dead skin areas and stop necrosis. The technique is used in the treatment of gangrene of the limb, severe burns, which are manifested in bed sores by bedsores. It starts the process of natural healing of wounds, rejuvenates the skin and at the same time has a completely biological background.

Treatment of gangrene in diabetes with the help of the regenerative matrix ZhKIM is aimed at improving the quality of life of the patient. Using this technique, it is possible to restore blood circulation in the affected limbs and stop the necrotic processes that often develop with the progression of diabetes.

The operating principle of the regenerative matrix ZhKIM

The regenerative matrix works through wave genetics using fluid that has been biologically programmed. It is she who starts the treatment of the initial stage of gangrene with the restoration of the organ or skin. The information contained inside the biological fluid contains the most detailed data on the initial state of the body. This contributes to the self-reproduction of healthy cells replacing those affected by necrosis.

The data transmitted by wave means contains the memory of a healthy state. The use of LCD information with careful processing of the damaged area allows them to be transmitted at a quantum level. In the treatment of dry gangrene, this provokes a complete stop of the death of organic cells and the start of their active reproduction by the division method, which helps to quickly restore the affected area and leads to the patient's recovery. The impact on the tissue does not occur on the physical, but directly on the information level - many times faster and more efficient.

Symptoms of wet gangrene

A distinctive feature of wet gangrene is that it can affect not only the limbs, but also internal organs. In this case, local symptoms and a general reaction to the infection occur. This is due to the presence of putrefactive microbes, which are absent when dry. They gradually destroy human tissue, releasing toxins into the blood. As a rule, the disease spreads quite slowly to healthy areas, therefore it has a more favorable prognosis than anaerobic gangrene.

Local manifestations

The most common local symptoms of wet limb gangrene are:

  • Change the color of the tissues to cyanotic or dark purple. At the same time, there is no clear border between healthy and affected areas, since the body cannot stop the spread of microbes. The transition area can be detected by the following signs: redness of the skin, increased local temperature, and the presence of soreness,
  • The smell of decay from the affected area,
  • Swelling and pastiness of the infected part of the arm / leg,
  • Constant acute pain in the infected limb, which occurs due to irritation of the receptors surrounding the gangrene tissue,
  • Decrease in temperature of the dead sites.

Similar symptoms will occur with nome.

Gangrene "diabetic foot". In patients with diabetes mellitus, which is difficult to treat, the functioning of blood vessels is disturbed. A typical manifestation is a lack of blood supply to the foot, which is why infection easily penetrates through any wound. Since the defense processes are also impaired, patients may develop symptoms of leg gangrene.

To prevent this outcome, even small wounds should be treated with antiseptic solutions (Fukortsin, Brilliant green, etc.) and healing drugs (Levomekol). A bactericidal patch or dressings are also required. If no improvement is observed within 2 days, consult a doctor.

Wet gangrene of the internal organs manifests itself in different ways, depending on localization. Currently, the most affected are: lungs, intestines and gall bladder. The following symptoms are characteristic of them:

The first 7-10 days, symptoms may be limited to periodic wet cough, with a small amount of sputum. Perhaps hemoptysis.

During the height of the lung gangrene is manifested as follows:

  • Cough with profuse sputum - about a liter / day. It is green or gray-earthy in color, with a strong putrid smell, viscous,
  • Chest pain aggravated by laughter, coughing and sneezing. As a rule, it is acute, appears on two sides,
  • Frequent hemoptysis,
  • Dyspnea of ​​varying severity. The more lungs are affected, the stronger the shortness of breath. As a rule, it occurs after small physical exertion.
Affected organCharacteristic symptoms
Lungs
AppendixWet gangrene of the appendix is ​​always preceded by acute appendicitis, showing the following symptoms:

  • Constant pain, strong or moderate intensity, aching in nature. Most often, it begins in the upper abdomen and after a few hours migrates the right lower abdominal wall,
  • It is possible to increase the temperature to 37-38 о С,
  • Diarrhea / constipation.

The development of gangrene will be indicated by the temporary disappearance of pain (for 3-8 hours), and then their significant increase. Additionally appears:

  • Abdominal muscle tension
  • Lack of stool
  • Persistent nausea
  • High temperature up to 40 о С.
Intestines
  • Severe pain of an acute nature over the entire surface of the abdomen. The patient cannot indicate a specific place "where it hurts",
  • Lack of stool
  • Persistent nausea and vomiting
  • Raising the temperature to 38-40 o C.
Gall bladderSymptoms are similar to intestinal gangrene, as gallbladder gangrene is often complicated by peritonitis (infection of the peritoneum)

General symptoms

Regardless of the location of wet gangrene, the patient always has general symptoms. They develop due to intoxication of the body by the waste products of putrefactive microbes. Symptoms are non-specific, as they occur in most severe infectious diseases. Most often, in patients observed:

  • Raising the temperature to 38-39 ° C. With gangrene of the organs of the abdominal cavity, an increase of up to 40 ° C is possible, due to the development of peritonitis,
  • Weakness,
  • Loss / loss of appetite,
  • Persistent nausea and dizziness,
  • Sweating enhancement,
  • In children under 6 years of age, seizures may occur, since their immune system can not cope with such a serious illness,

In senile people, these symptoms may be less pronounced, as their body cannot adequately respond to infection.

Symptoms of Anaerobic Gangrene

The most severe form of the disease is airless or anaerobic gangrene. The main difference between this form and the wet one is that the infection does not occur with ordinary putrefactive microbes, but with clostridia - gas-forming anaerobic bacteria. They can only live without air, so they grow well on dead tissues and in closed wounds. Due to the release of a large number of dangerous toxins, clostridia destroys the muscles, fatty tissue and skin around the area of ​​its growth. Микробы быстро распространяются по инфицированной конечности и вызывают сильную интоксикацию.

The site infected with anaerobic gangrene has a characteristic appearance:

  1. Pale cold skin. Perhaps the appearance of blue or reddish spots around the wound,
  2. Severe swelling of the tissues, which is constantly increasing. When probing, the limb has a pasty consistency,

  1. A cloudy liquid with a fetid odor, greenish or brown, can be separated from the wound,
  2. If muscles are visible in the wound, then they look like “boiled meat”: whitish in color, pale, with stratified fibers,
  3. Feeling an infected leg / arm, one can feel the “crunch” (crepitus) characteristic of anaerobic gangrene only.

With anaerobic infection, general symptoms always prevail over local manifestations. As a rule, it is pronounced intoxication that leads to the death of patients. Typical manifestations of poisoning the body with toxins of clostridia are:

  • Severe weakness to adynamia (the patient cannot move),
  • Temperature increase up to 39-41 о С,
  • Violation of sleep and consciousness (delirium is possible),
  • Constant nausea and vomiting, after which relief does not occur,
  • Blood pressure, most often, drops below 100/70 mm Hg. A decrease of an additional 30 mm Hg is an unfavorable sign,
  • Tachycardia - the pulse increases to 100-120 beats / min. The patient may feel a heartbeat.

Damage to the kidneys, liver and brain by microbial toxins is also possible. If measures to improve the patient's condition have not been taken in a timely manner, the likelihood of death from anaerobic infection is extremely high.

Symptoms of bedsore

The death of tissues with this form develops gradually. In the initial phase of the disease, the skin, which is under constant pressure, becomes pale. Temperature and pain sensitivity are slightly reduced. After 2-3 days, tissue edema appears. Blackening of small areas is possible, which is a reliable sign of developed gangrene.

If adequate bedsore treatment has not been carried out, an infection joins in a few days. This leads to the appearance of such general symptoms as temperature 38-39 ° C, weakness, nausea / vomiting, increased sweating.

Diagnosis of lesions of the lower extremities

This diagnosis can be made only on the basis of patient complaints and examination results. Additional diagnostic measures are carried out to assess the condition of the patient or to determine the type of microbe and its sensitivity to antibiotics. In the first case, perform:

  • KLA (clinical blood test) - an increase in ESR (more than 20) and white blood cell count (more than 10 * 10 9 / l). A decrease in the number of leukocytes (less than 4 * 10 9 / l) is a bad sign, as it shows the patient's immunity is insolvent,
  • Biochemical analysis of venous blood - an increase in the content of C-reactive protein (more than 10 mg / l). An increase in the amount of Creatinine (more than 110 mmol / L) and Urea (more than 8 mmol / L) with anaerobic gangrene is an unfavorable sign, as it may indicate the onset of development of renal failure,
  • Clinical analysis of urine - changes only with anaerobic. The appearance of protein or glucose. The development of kidney failure will be indicated by a decrease in urine density (less than 1015), creatinine levels (less than 0.5 g / day), urea (less than 20 g / day).

To determine what type of bacteria is in the wound, make a bacterial smear smear from the infected area. As a rule, its results can be found no earlier than a week later.

If it is not possible to determine the type of gangrene (for example, wet or anaerobic) by examination, an x-ray of the infected limb is performed. If gas bubbles are visible in the image, this is a reliable confirmation of the anaerobic process.

Diagnosis of internal organs

Confirm gangrene with such an arrangement, as a rule, is not possible with the data of the survey and inspection. An exception is constricted hernia. For diagnosis, the following diagnostics are recommended:

Affected organDiagnostic procedures
Lung
  • Chest X-ray / Computed Fluorography - Irregularly shaped x-ray “tricks” are visible. The airiness of the lungs is reduced, which is manifested by darkening. Decryption of the image should be done only by a qualified doctor,
  • Bronchoscopy - performed using an endoscopic instrument of the bronchoscope. It is a thin elastic tube that is inserted into the bronchus to examine it. It is performed under general anesthesia.
IntestinesIf gangrene was not caused by an infringement of the hernia, endoscopic methods help to make a diagnosis:

  • Colonoscopy - the introduction of a special instrument with a camera and a light source into the intestinal cavity, through the anus,
  • Laparoscopy - a similar instrument is used, but it is administered through a small incision (1-2 cm) of the anterior abdominal wall.
AppendixAs a rule, instrumental diagnosis of gangrene of the appendix or gall bladder is not carried out. This is due to the fact that acute gangrenous cholecystitis / appendicitis, in most cases, have a characteristic course:

  • The patient for a long time (up to 7 days) is concerned about acute pain,
  • For a short time (up to 12 hours) the pain completely stops. The patient feels "cured"
  • Soon, the pain returns, but much more severe, over the entire surface of the abdomen. There is tension in the anterior abdominal wall.

In the vast majority of cases, patients are treated only in the third stage, when they develop peritonitis (peritoneal inflammation)

Gall bladder

Having diagnosed "gangrene", the patient is immediately placed in a hospital and proceed to complex treatment.

High efficiency of wave genetics and LCD

Many medications can be used to treat gangrene of the foot or finger. In some cases, resort to hormonal and replacement therapy, experiments were carried out with donor stem cells. But such high results as in the information processing of cells, according to statistics and reports, were not achieved anyway. The whole problem is that it is possible to obtain spectra of cells not affected by pathology and deliver them to the recipient precisely using the wave genetics method.

Classical genetics in the treatment of gangrene of the lower extremities without amputation is aimed at experiments with bacteria. For this purpose, one microorganism is taken, another is introduced into it, and as a result, a hybrid is obtained that has all the properties of the necessary medicine. When using the wave method, everything happens remotely - the quantum equivalents of human genes from the initial state are copied to a biologically active liquid, changing the metabolism of the object. Thus, the ZhKIM matrix acts not only on the manifestation of gangrene, but also on the underlying causes that cause it. This avoids necrosis, trophic ulcers, as well as amputation.

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