Gangrene - Dry and Wet Gangrene, Treatment, Fournier's gangrene

Definition

Massive death of tissue with putrefaction is called gangrene. ( slough: Dead piece of soft tissue, skin, fascia, tendon).

Gangrene

Classification

There are two types of gangrene
A. Dry Gangrene
B. Moist Gangrene or Wet Gangrene



According to cause:

Secondary gangrene RESTED

Infective - Boil, Carbuncle, gas gangrene

Traumatic

  1. Direct - Gush injury, pressure sore contraction of strangulated bowel
  2. Indirect - Due to injury of vessels at some distance from the site of gangrene
Physical gangrene - Burn, scald, frostbite, electricity

Venom gangrene - Peripheral thrombosis of veins (Extensive)



Treatment of gangrene

General

Care of heart
Correction of anemia
Relief of pain by suitable analgesics
Nutritious diet
Control of blood sugar in diabetics


Local

Conservative
(Limb shaving attitude)
The part should be kept absolutely dry
Cool (reduce local metabolism and O2 demand) in TAO (Thrombo Angitis Obliterans)
Care of pressure points



Operative

Sympathetic denervation to improve blood supply in TAO
Minor surgical toileting - removal of slough, eschar and release of pus
In traumatic injury to blood vessels direct vascular surgery
Amputation - As a life shaving measure



Dry gangrene

Gradual onset and slow progress
Gradual arterial occlusion and unimpaired venous drainage
Affected part dried, mummified
Skin wrinkled, greasy to touch, and more or less shiny due to loss of fat. Discolored look due to deposition of iron-sulfide.
Mild sepsis and putrefaction
The sharp line of demarcation
Toxemia light

Examples
Senile gangrene


Moist or Wet gangrene

Sudden onset and rapid progress
Sudden and simultaneous arterial and venous occlusion
Affected part is moist, edematous with surface blisters and stinking smell
Skin is edematous with surface blebs, discolored congested, and purplish in appearance
Gross sepsis and putrefaction
Line of demarcation vague
Toxemia marked

Examples

Diabetic gangrene
Acute traumatic gangrene
Acute appendicitis
Strangulated bowel



Fournier's gangrene of the scrotum

Cause

This is a quickly spreading gangrene of scrotum, the came off which is not definitely known. The usual explanation is that there are obliterative arteries of the arterioles supplying the scrotal skin, resulting from a fulmination inflammation tissue of the scrotum (usually streptococcal, some times staphylococcal, B coli, Cl. welchii)


Clinical feature

There is a sudden appearance of inflammation in the scrotum which quickly progresses to gangrene. Gangrene usually spreads or distributed all over the scrotum and even surrounding skin and may be extended to outside of the scrotal sac.


Treatment

An antibiotic is started at the sending the discharge for culture and antibiotic sensitivity test.
Can use an antibiotic ointment
If no response the gangrenous skin is excised
Later an operation is undertaken to cover up the testis.

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