Wet Gangrene - Causes, Symptoms And Treatment

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Wet gangrene

A type of necrotic decay of tissues, which arose as a result of a lack of blood circulation due to trauma, a thrombus entering the vessel, a bone fragment in a fracture, as well as metabolic and vascular disorders in patients with diabetes mellitus, is called wet gangrene.

Content:

• About the disease
• Causes of wet gangrene
• Wet gangrene symptoms
• How is the disease diagnosed?
• Wet gangrene treatment methods

About the disease

In this form of gangrene, body tissues undergo putrefactive decomposition. The disease proceeds rapidly, has an extremely unfavorable outcome due to the rapidly growing intoxication of the body. Most often, gangrene occurs on the upper and lower extremities, although it also occurs in the lungs, intestines, and gallbladder. If the patient does not make an urgent amputation of the affected limb or organ, a lethal outcome is inevitable.

Infection with pathogenic bacteria is always a catalyst for wet gangrene. As a result of their activity in the tissues of the body, the process of cadaveric decomposition starts. The patient's immune system is unable to delimit the affected area of the limb or organ from healthy tissue. The necrotic process rapidly spreads further, and the toxins resulting from the decay of a large number of cells enter the systemic circulation, disrupting the functioning of the body.

Gangrene of this type is especially difficult in patients with diabetes mellitus for the following reasons:

• Low body resistance;
• Increased susceptibility to septic and purulent infections;
• Violation of the regenerative properties of tissues.

Gangrene of the lungs and intestines is always wet.

Causes of wet gangrene

At the heart of a sudden circulatory disorder that provokes the onset of pathology, there is always a vascular accident or trauma.

Death - traumatic causes:

• Frostbite;
• Thermal or chemical burn;
• An open wound with damage to a large artery;
• Crushing or mechanical crushing of tissues;
• Compression of blood vessels (with a long-term imposed hemostatic tourniquet);
• Small wound or abrasion in patients with diabetes mellitus;
• Closed comminuted fracture with damage to the artery.

Wet gangrene - vascular causes:

• Embolism of a vessel when a blood clot enters it, a piece of adipose tissue with a fracture;
• Atherosclerosis - cholesterol plaque overlap the vessel lumen;
• Obliterating endarteritis - vasoconstriction of the extremities in smokers;
• Thromboembolism of the pulmonary artery, which caused pulmonary gangrene;
• Infringement of the hernia, which caused intestinal gangrene;
• Compression of the wall of the gallbladder with a stone, which caused gangrene of this organ.

Not every injury or compression of tissues leads to the appearance of necrotic changes. For the beginning of the pathological process, strong prerequisites are necessary.

Predisposing factors:

• Features of metabolism in overweight patients;
• Avitaminosis;
• Exhaustion;
• History of endocrine pathologies;
• Infectious diseases;
• Additional intoxication with alcohol, nicotine, chemicals;
• Postponed traumatic shock;

• Overheating or excessive cooling of blood vessels in combination with impaired blood supply;
• Destruction of body structures by aggressive media (alkali, acid), electric current;
• Infection of tissues with pathogenic microbes;
• Heart and renal failure, provoking additional edema, disrupting metabolism;
• Damage to the main vessel, as a result of which the blood supply to a large area of the body is disrupted.

Streptococci, Escherichia coli, and enterobacteria are involved in wound infection with wet gangrene. Most often, they get into a wound with a gunshot or stab wound, although they can enter the body from the soil or with a nosocomial infection.

Wet gangrene symptoms

At the initial stage of the disease, the limb becomes cold, the vascular network appears on it, the skin acquires a marble pattern. Arm or leg movements are limited or impossible, the pulse is weak or completely absent. In this case, the patient experiences severe pain. The deterioration of the condition occurs after 1-2 days from the onset of the disease.

Symptoms of the further development of wet gangrene:

• A strong, rapidly increasing edema appears, spreading throughout the limb;
• Blisters with red or brown hemorrhagic fluid appear on the skin;
• The limb structures are exposed, they are dirty gray in color;
• The skin in the affected area becomes blue or black with a greenish tint;
• Decaying tissues and waste products of bacteria produce an extremely unpleasant putrid odor;
• A dirty green or brown exudate of a liquid consistency is released from the wound; in the muscles it takes the form of a thicker substance;
• From the periphery of the limb, necrosis rapidly spreads to the center, there is no clear boundary between the affected and healthy tissue.

The increase in intoxication leads to the appearance of symptoms of general poisoning:

• Heat;
• Weak pulse;
• Low blood pressure;
• Apathy;
• Gray complexion;
• Dry tongue;
• Headache;
• Increased fatigue, weakness.

With gangrene of the lungs, a persistent cough occurs, coughing up a large amount of fetid sputum (up to a liter per day). Severe pain appears in the chest, which becomes more intense with inhalation and deep breathing. Wet gangrene of the lungs proceeds with lightning speed, patients die in the first few days.

With intestinal gangrene, the patient is diagnosed with constipation, bloating, blood in the stool, nausea and vomiting. The stomach hurts, the body temperature rises rapidly. If the patient is not given urgent help, intestinal gangrene is complicated by peritonitis and leads to death.

How is the disease diagnosed?

Symptoms of wet gangrene should be referred to a vascular or general practitioner surgeon. Treatment of wet gangrene is carried out in the department of purulent surgery, with diagnosed gangrene of the lung, a thoracic surgeon can help. At the initial appointment with the doctor, the patient is interested in the presence of diabetes mellitus, cardiovascular diseases.

During a visual examination of the wound, the surgeon pays attention to the following parameters:

• Color of the skin;
• The presence of edema;
• Skin condition;
• The presence or absence of crepitus (characteristic crunch).

When the diagnosis is confirmed, the patient is sent to the hospital for a complete examination and treatment.

Laboratory and instrumental research:

• General and biochemical blood test;
• A blood test for sterility to detect sepsis;
• Bacteriological sowing of exudate to identify the sensitivity of pathogens to antibiotics;
• Extremity X-ray;
• Bronchoscopy, CT, or chest ultrasound if lung gangrene is suspected;
• Microscopic and bacteriological examination of sputum with gangrene of the lung;
• X-ray of the abdomen for signs of bowel necrosis;
• Laparoscopy to identify lesions in wet intestinal gangrene.

If the patient requires resuscitation measures, he is transferred under the supervision of a resuscitator.

Wet gangrene treatment methods

Partial removal of necrotic tissue with wet gangrene is ineffective. Most often, a radical method is used - guillotine amputation of a limb to healthy tissue. The operation is carried out in 2 stages - first, amputation is performed, and after cleaning the wound, a stump is formed.

The main directions of treatment:

• Amputation of the necrosis focus;
• Elimination of the infectious factor;
• Relief of general intoxication of the body;
• Correction of metabolism in diabetes mellitus.

With gangrene of the intestine or gallbladder, diagnostic and therapeutic laparotomy is performed with the removal of a necrotic organ, sanitization of the abdominal cavity.

Preparations to eliminate infection:

• Broad-spectrum antibiotics;
• Local antiseptics;
• Sulfonamides;
• Nitrofurans;
• Immunomodulators;
• Anti-gangrenous sera;
• Vaccines.

Detoxification measures:

• Transfusion of blood substitutes (plasma, blood, albumin, hemodez);
• Infusion (droppers) of glucose, colloidal and crystalloid solutions, isotonic sodium chloride solution, low molecular weight polyglucin;
• Forced diuresis of diuretic and cardiac glycosides;
• Plasma sorption;
• Hemisorption;
• Ultraviolet blood irradiation.

With wet gangrene, complications associated with impaired functionality of the heart, kidneys, and liver may appear. Gangrene of the lung can be complicated by pulmonary hemorrhage, the development of sepsis. Peritonitis and sepsis, complicating the course of intestinal gangrene, often cause death of the patient.

For the prevention of wet gangrene, burns and frostbite, infections of the respiratory system should be promptly treated. Correct treatment of vascular pathologies, prevention of foot injuries in diabetes mellitus will help prevent the onset of the disease.

The author of the article: Volkov Dmitry Sergeevich | c. m. n. surgeon, phlebologist

Education: Moscow State University of Medicine and Dentistry (1996). In 2003 he received a diploma from the Educational and Scientific Medical Center of the Presidential Administration of the Russian Federation.