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gangrene

Gangrene

Related Terms: lymphedema, tissue death, dry gangrene, wet gangrene, gas gangrene, Clostridia, frostbite, arteriosclerosis, smoking, Raynaud's disease, atherosclerosis , debridement, hyperbaric oxygen therapy, amputation, foot care, black toe, edema, swelling, IV antibiotic, embolic gangrene, symmetric gangrene, segmental gangrene, clostridial myonecrosis, Buerger's Disease, Gastric gangrene, Acute necrotizing gastritis, diabetes mellitus, ethylism, antiphospholipid antibodies, thrombosis, anticardiolipin antibodies, systemic lupus erythematosus, digital gangrene, Bladder cancer, penile gangrene, priapism

Gangrene literally stands for “tissue death.” and is the end complication of either a non treated infection, or in an infection that the physicians were not able to stop or contain.

I am including this page, in addition to the various pages on infections because we are especially susceptible to this with the infections we get. I can not stress enough or say enough that our lymphedematous limb is immunocompromised due to the impaired lymphatic system. In addition, the intensity of the fibrosis that so often accompanies lymphedema can sometimes make it close to impossible for the antibiotics we are given to reach.

If you have any symptom of an infection of any type, it must be treated prompt;y. If you are a lympher like myself who has a particular sensitivity to infections, then it may be a good idea to discuss a prophylactic daily antibiotic. You should also have an infectious disease doctor on your lymphedema treatment team.

Any injury that breaks the skin, no matter how small also must be treated promptly. You can get an infection through something as tiny as a pin prick.

Finally, there are some with lymphedema with such extensive fibrosis that it can reduce the blood supplly to the affected limb. As we will read below, ganagrene is associated with such a reduction.

Pat

Feb 4, 2012

Types of Gangrene

Sub-Types of Gangrene

Dry gangrene is caused by a reduction of blood flow through the arteries. .It may also be referred to as “mummification. Dry gangrene may result in/from conditions in which circulation is compromised (diabetes, atherosclerosis, arterial destruction. It may occur slowly with the fore mention conditions. It may spread quickly if occurrence Is from frostbite, elastration castration, burdizzo (castration tool). IT occurs only in the extremeties (limbs) and the limb tissues become dry and shriveled.

Signs of this type of gangrene include gradual shrinking of the tissue, which becomes cold and lacking in pulse, and turns first brown and then black. Usually a line of demarcation is formed where the gangrene stops, owing to the fact that the tissue above this line continues to receive an adequate supply of blood.

Wet gangrene or “moist” gangrene caused by sudden stoppage of blood, resulting from burning by heat or acid, severe freezing, physical accident that destroys the tissue, a tourniquet that has been left on too long, or a clot or another embolism. At first, tissue affected by moist gangrene has the color of a bad bruise, smells atrociously, is swollen, and often blistered. The gangrene is likely to spread with great speed. Toxins are formed in the affected tissues and absorbed.

Gas Gangrene is a bacterial infection that produces gas with tissue. This is a deadly form of gangrene that requires immediate and intensive treatment. The gases produced easily infiltirate surrounding tissues and as a result spreads rapidly.

This may also be referred to as clostridial myonecrosis. That term describes infection of muscle tissue by toxin-producing clostridia.

Noma is gangrene of the face. May be also referred to as orofacial gangrene. This may begin as a simple ulcer usually in the gingival. It may spread rapidly and become an acute necrotizing ulcerative stomatis. The necrosis can then extend into the maxilla, lips, cheeks,orbit, nose and facial soft tissues. (3)

Fournier gangrene usually affects the male genitals and groin. This gangrene may also be referred to as necrotizing fasciitis of the perineum and genitalia, or synergistic necrotizing fasciitis of the perineum and genitalia Fournier gangrene is a rapidly progressive infective gangrene involving the scrotum, penis, and/or perineum. This can be caused by local trauma, surgeries, or urinary disease .(4)

Other “types” of gangrene include:

Embolic gangrene a condition following cutting off of blood supply by embolism.

Symmetric gangrene gangrene of corresponding digits on both sides, due to vasomotor disturbances.

Segmental gangrene which is gangrene of a section of an organ, e.g. of part of an elephant's ear, as a result of sectional compromising of blood supply.

Causes

A serious injury, wound, blood vessel disease ((such as arteriosclerosis, also called hardening of the arteries, in your arms or legs), diabetes, suppressed immune system (HIV, chemotherapy or iodiopathic leucopenia), surgery.

Symptoms

If the gangrene has skin involvement, or if the gangrene is close to the skin, the symptoms may include discoloration of the tissue ((blue or black if skin is affected; red or bronze if the affected area is beneath the skin) (2)

There will be a foul smell to the area and a loss of feeling in the affected area.

If the affected area is inside the body (such as gangrene of the gallbladder or gas gangrene), the symptoms may include: Confusion, Fever, Gas in tissues beneath the skin, General ill feeling, Low blood pressure, Persistent or severe pain (2)

If the affected are is inside the body (example in an organ), the symptoms may include: Confusion, Fever, Gas in tissue, general ill feeling or feeling of malaise, low blood pressure and a persistent and/or severe pain in the affected area.

Diagnoses

Initial suspicion of gangrene is through physical examination.

Other tests used in the diagnosing and ascertaining of the extent of the gangrene may include blood tests (whit blood cell of WBC), Arteriogram to see any blood flow blockages, CT scan of the internal organs, culture of the tissue and/or fluid to determine the specific bacterial cause. Microscopic examination of the tissue and surgery to remove any dead tissue.

In dry gangrene angiography (A procedure performed to view blood vessels after injecting them with a radioopaque dye that outlines them on x-ray )may be used that shows blood flow in the tissues.

Treatment

The treatment of gangrene includes the use of antibiotics (intravenously), amputation of the affected limb, surgery to remove dead tissue in other areas. Sometimes a series of surgeries or debridements may be required.

Finally, for the severely ill patients, you would most likely be placaed in the ICU.

Studies indicate gangrene may also be treated through the use of hyperbaric oxygen. It not only improves the oxygen

Prognosis

A specific prognoses is difficult to state as it depends on numerous factors. These include any underlying disease or comobidity, where the gangrene is, how much there is, on whether or not it has spread, and if treatment was delayed.

If treatment is not promptly and effectively, gangrene can be fatal.

Complications

Complications are also going to be determined by the patients over-all health, comobidities, where the gangrene is, how extensive it is and the cause.

The complications themselves include amputation of the affected limb, or disability from the removal of dead tissue.

Prolonged wound healing and the possibility of reconstructive surgery including skin grafting.

Prevention

The most important steps in the prevention of gangrene is immediate treatment of any type of infection and/or wound.

Abstracts and Studies

Factors affecting the number of debridements in Fournier’s gangrene: our results in 36 cases.

Jan 2012

Göktaş C, Yıldırım M, Horuz R, Faydacı G, Akça O, Cetinel CA. Source Department of Urology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey.

Abstract

BACKGROUND: We aimed to evaluate the factors potentially affecting the number of surgical debridements in patients with Fournier’s gangrene (FG) who underwent single or multiple operative sessions.

METHODS: We retrospectively reviewed the data of 36 patients with FG. The patients were assigned to one of two groups according to the number of debridements (Group I: single session; Group II: ?2 sessions). Data of the patients (clinical and surgical data, lesion characteristics, FG severity index, and prognosis) were compared between the groups.

RESULTS: The mean age of the patients was 55.5 years, and all were male. Group I consisted of 21 patients and Group II of 15 patients. The mean number of debridements was 2.2 in Group II. Our overall mortality rate was 11% (Group I: 4.8% vs Group II: 20%; p=0.287). Diabetes was the most common coexistent pathology (44%). Time to admission to the clinic, size of the lesions at admission, and FG Severity Index (FGSI) scores of the groups were similar. In Group II, FGSI scores were found increased before each of the repeated debridement sessions (p<0.05).

CONCLUSION: There was no difference in the clinical data of the patients who required single or multiple debridement sessions; however, FGSI may be useful in deciding repeated debridements, as it was found increased at each repeated session.

PubMed

Curative Treatment Without Surgical Reconstruction After Perineal Debridement of Fournier'sGangrene.

Jan 2012

Jones EG, El-Zawahry AM. Source Elizabeth Geiger Jones, MSN, RN, APN-BC, CWCN, Nurse Practitioner (retired), Ralph H. Johnson VA Medical Center, Charleston, South Carolina. Ahmed M. El-Zawahry, MD, MSc, Clinical Instructor, Department of Urology, Ralph H. Johnson VA Medical Center, Charleston, South Carolina and Medical University of South Carolina, Charleston.

Abstract

BACKGROUND: : Fournier's gangrene (necrotizing fasciitis) is an acute life-threatening disease of the perineal area that requires urgent medical intervention. Once the affected area is surgically debrided and the patient is stabilized, surgical management typically involves 1 or more additional procedures that may include split-thickness skin grafts, flaps, or an elective diverting urostomy and/or colostomy. The professional literature discussing nonsurgical approaches to healing for Fournier's gangrene after surgical debridement is sparse.

CASE: : We present 3 cases of male patients with Fournier's gangrene from our facility who healed uneventfully with negative pressure wound therapy placed after extensive debridement without further surgical intervention. An added benefit was a satisfactory aesthetic effect.

CONCLUSION: : Expert wound management including negative pressure wound therapy after surgical debridement of Fournier's gangrene eliminated the need for further operative procedures and prolonged hospitalizations in these cases. We believe that surgical teams should consider using negative pressure wound therapy as part of the initial curative plan of care after debridement, and that plans for restorative plastic surgery should be restricted to patients who do not exhibit adequate improvement with conservative wound management.

Woundm Ostomy and Continence Nursing

Gangrene of the auricle as the first sign of antiphospholipid antibody syndrome.

Dec 2011

[Article in English, Portuguese]

de Sá EB, da Silva Passos A, Cecconi M, Barbo ML, Martinez JE, Novaes GS. Source Departamento de Morfologia e Patologia, PUC-SP. erikabettini@hotmail.com

Abstract

Antiphospholipid syndrome (APS), more common in females, manifests clinically as thrombosis and/or recurrent fetal loss. Hemolytic autoimmune anemia and neurological, cardiac and cutaneous manifestations are common. This is the case report of a male patient whose first manifestation of the disease was gangrene of the auricle. The diagnosis of APS was established by biopsy of the lower limb skin, which showed thrombotic vasculopathy with no evidence of vasculitis. This is one of the two major criteria, which, along with a minor criterion, establishes the diagnosis of APS. Possible differential diagnoses are discussed. The importance of the biopsy in the APS diagnosis of this male patient is emphasized.

SciElo

A case of Fournier's gangrene after liver transplantation: treated by hyperbaric oxygen therapy.

2011

Yoshida N, Yamazaki S, Takayama T. Source Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan.

Abstract

Fournier's gangrene (FG) is known as a rapidly progressing necrotizing fasciitis arising from genitourinary and colorectal infections. Misdiagnoses have occurred often because the initial presentation varies and is unclear. We report a case of FG in a 59-year-old man who had undergone a living donor liver transplant. He was in the maintenance phase of immunosuppressant treatment. FG occurred rapidly without symptoms and required prompt and aggressive debridement. Computed tomography demonstrated a small air density in his left testis. Treatment with hyperbaric oxygen therapy followed by intra- operative Gram's staining navigated debridement was additionally performed with general systematic anti-biological therapy and successfully cured the patient. Extra caution should be paid to patients who are maintained on immunosuppressants. Earlier detection and intervention will reduce the rate of mortality to a minimum.

BioScience Trends

Strangulated tension viscerothorax with gangrene of the stomach in missed traumatic diaphragmatic rupture.

2011

Onakpoya U, Ogunrombi A, Adenekan A, Akerele W. Source Cardiothoracic Surgery Unit, Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife 220005, Nigeria. Uvie Onakpoya: Email: uvtoyin@yahoo.com

Abstract

Acquired diaphragmatic hernias are usually posttraumatic in occurrence. In patients who have blunt trauma and associated diaphragmatic hernia, the diagnosis may be missed or delayed, often leading to poor treatment outcomes. We present a rare occurrence of tension viscerothorax due to missed traumatic diaphragmatic rupture in a 25-year-old woman whose condition was complicated by gangrene and perforation of the fundus as well as questionable viability of the anterior wall of the body of the stomach. The patient had a successful emergency transabdominal suture plication of the diaphragm and gastroplasty and has remained symptomless 3 months postoperatively.

ISRN Surgery

Sugar inhibits the production of the toxins that trigger clostridial gas gangrene. Jan 2012 Méndez MB, Goñi A, Ramirez W, Grau RR. Source Departamento de Microbiología, Facultad de Ciencias Bioquímicas y Farmacéuticas, Hospital Provincial del Centenario, Universidad Nacional de Rosario, CONICET, Rosario, Argentina. Abstract Keywords:** Gas gangrene regulation; Clostridium perfringens; Toxin production; Carbon signalling; Wound healing; Sugar; Carbon catabolite repressio

Histotoxic strains of Clostridium perfringens cause human gas gangrene, a devastating infection during which potent tissue-degrading toxins are produced and secreted. Although this pathogen only grows in anaerobic-nutrient-rich habitats such as deep wounds, very little is known regarding how nutritional signals influence gas gangrene-related toxin production. We hypothesize that sugars, which have been used throughout history to prevent wound infection, may represent a nutritional signal against gas gangrene development. Here we demonstrate, for the first time, that sugars (sucrose, glucose) inhibited the production of the main protein toxins, PLC (alpha-toxin) and PFO (theta-toxin), responsible for the onset and progression of gas gangrene. Transcription analysis experiments using plc-gusA and pfoA-gusA reporter fusions as well as RT-PCR analysis of mRNA transcripts confirmed that sugar represses plc and pfoA expression. In contrast an isogenic C. perfringens strain that is defective in CcpA, the master transcription factor involved in carbon catabolite response, was completely resistant to the sugar-mediated inhibition of PLC and PFO toxin production. Furthermore, the production of PLC and PFO toxins in the ccpA mutant strain was several-fold higher than the toxin production found in the wild type strain. Therefore, CcpA is the primary or unique regulatory protein responsible for the carbon catabolite (sugar) repression of toxin production of this pathogen. The present results are analyzed in the context of the role of CcpA for the development and aggressiveness of clostridial gas gangrene and the well-known, although poorly understood, anti-infective and wound healing effects of sugars and related substances.

SciVerse

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gangrene.txt · Last modified: 2012/10/16 14:40 (external edit)