What is Gangrene………

Gangrene is the death of tissue in part of the body.

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


Causes, incidence, and risk factors

Gangrene can occur when a body part loses its blood supply. This may happen from, for example, injury or infection. You have a higher risk for gangrene if you have:


• Diabetes
• Blood vessel disease (such as arteriosclerosis in your arms or legs)
• A serious injury
• Surgery
• Immunosuppression (for example, from HIV or chemotherapy)




Types of Gangrene:

Dry gangrene

Dry Gangrene begins at the distal part of the limb due to ischaemia. A typical example of dry gangrene is the toes and feet of an old patient due to arteriosclerosis. Gangrene spreads slowly upwards until it reaches the point where the blood supply is adequate to keep the tissue viable. Macroscopically, the affected part is dry, shrunken and dark black, resembling the foot of a mummy. It is black due to liberation of hemoglobin from hemolysed red blood cell which is acted upon by the hydrogendisulfide(HG) produced by the bacterias resulting in formation of black iron sulfide. The line of separation usually brings about complete separation with eventual falling off of the gangrenous tissue if it is not removed surgically.
If the blood flow is interrupted for a reason other than severe bacterial infection, the result is a dry gangrene. Persons with impaired peripheral blood flow, such as diabetics, are at greater risk of dry gangrene.
The early signs of dry gangrene are a dull ache and sensation of coldness in the area, along with pallor of the flesh. If caught early, the process can sometimes be reversed by vascular surgery. However, if necrosis sets in, the affected tissue must be removed just as with wet gangrene.

Internal gangrene

In this gangrene the tissues become white. It is located inside the body, usually after surgery or trauma. Also called "white gangrene".


Wet gangrene

Wet Gangrene Occurs in naturally moist tissue and organs such as the mouth, bowel, lung, cervix vulva, etc. Diabetic foot is another example of wet gangrene due to high sugar content in the necrosed tissue which favour the growth of bacteria. Bedsores occurring in a bed-ridden patient due to pressure sites like the sacrum, buttocks and heels are the other important clinical condition included in wet gangrene. In wet gangrene, the tissue is affected by saprogenic microorganisms (Bac.perfringes, fusiformis, putrificans, etc), becomes swollen and emits fetid smell. It develops in the tissue rich in water: Lungs, Intestine, noma(water cancer) gangrene of cheeks in children at measles. Wet gangrene usually develops rapidly due to blockage of venous and/or arterial blood flow. The affected part is stuffed with blood which favour the rapid growth of bacteria. The toxic products formed by bacteria are absorbed causing systemic manifestation of septicemia and finally death. Macroscopically the effected part is swollen edematpus, soft, putrid, rotten, dark. The part is dark due to the same mechanism as in dry gangrene.

Gas gangrene

Gas gangrene is a bacterial infection that produces gas within tissues in gangrene. It is a deadly form of gangrene usually caused by Clostridium perfringens bacteria. Due to its tendency to progress rapidly, it is considered a medical emergency. The rapid progression of gas gangrene occurs because of the tendency of expanding gas to open and separate the internal tissues, progressively exposing more and more healthy tissue to infection.
Gas gangrene is caused by exotoxin-producing clostridial species, which is mostly found in soil, and other anaerobes (e.g. Bacteroides and anaerobic streptococci). These environmental bacteria may enter the muscle through a wound and go on to proliferate in necrotic tissue and secrete powerful toxins. These toxins destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen and 16.1% oxygen was reported in one clinical case.
Gas gangrene can cause myonecrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid.

Streptococcal gangrene: Necrotizing fascitis is a flesh eating bacteria











Signs and tests:

The doctor may diagnose gangrene from a physical examination. In addition, the following tests and procedures may be performed to diagnose gangrene:
• Blood tests -- a CBC may show a high white blood cell (WBC) count
• X-rays
• CT scan for internal conditions, such as abdominal pain
• Surgical exploration to confirm (and treat) gangrene
• Microscopic examination of tissue to look for cell death
• Tissue or fluid culture from wounds to identify bacterial infection
• An arteriogram to help plan treatment for vascular disease.

Homeopathic Treatment:

Arsenicum Alb- Dry gangrene especially in old peoples; Soreness, burning & restlessness are there which is relieved by warmth. It is often indicated in gangrene of the lungs.
Other symptoms which are present are fetid diarrhea, great weakness, emaciation, and feeling of coldness and heat alternately.

Secale Cor- Secale corresponds to senile gangrene with tingling and formication. Dry gangrene of toes; the skin becomes wrinkled and dry, shriveled and cold, no sensibility, black and free from foetor; Large ecchymoses and blood blisters, which becomes gangrenous, will indicate the remedy.

Carbo Vegetabilis- Carbuncle and boils, becoming gangrenous; There is no restlessness as in Aresenic, but the parts have a livid purple look, and they are icy cold. It also suits moist gangrene in cachectic persons whose vitality is weak; the secretions are foul and there is great prostration.

Other medicines which are used in gangrenes are Arnica, Lachesis, Crotalus, Carbolic Acid, etc.

Treatment:

Gangrene requires urgent evaluation and treatment. In general, dead tissue should be removed to allow healing and prevent further infection. Depending on the area affected, the condition of the patient, and the cause of the gangrene, treatment may include:
• An emergency operation to explore or remove dead tissue
• Amputating the affected body part
• Repeated operations to remove dead tissue (debridement)
• An operation to improve blood supply to the area
• Antibiotics
• Treatment in the intensive care unit (for severely ill patients)


Complications

Complications depend on the body part affected, the extent of gangrene, its cause, and the condition of the patient. Complications may include:

• Disability from amputation or removal of dead tissue
• Prolonged wound healing or the need for reconstructive surgery, such as skin grafting

Calling your health care provider

Call your doctor immediately if:

• An area of your skin turns blue or black
• You have persistent, unexplained pain in an area
• You have persistent, unexplained fever
• A wound does not heal or there are frequent sores in an area
• There is foul-smelling discharge

Prevention:

Gangrene may be prevented if a harmful process is treated before the tissue damage is irreversible. Wounds should be treated properly and observed for signs of infection (such as spreading redness, swelling, or drainage) or failure to heal. Patients with diabetes or blood vessel disease should routinely examine their feet for any signs of injury, infection, or change in skin color and seek care as needed.


John Botrey lived for 15 years with devastating deformity and disability resulting from the tropical gangrene-like disease, Noma, known as “the face of poverty”