Gangrene Of The Lower Extremities - Types And Symptoms Of Gangrene

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

Types, causes and symptoms of gangrene

Gangrene is a rather complex disease characterized by necrosis. The causes of gangrene are different. Tissue death can be the result of insufficient blood circulation through the vessels or complete cessation of blood circulation in a certain part of the body, as well as the result of exposure to adverse external factors, for example, chemicals, electric current, high or low temperatures.

A characteristic sign of gangrene is a change in the color of tissues affected by the necrotic process. They turn black or earthy gray. If an infectious infection occupies a large area, and therapy of the disease began untimely, a third of patients die, and the rest become disabled. To increase the chances of returning to a fulfilling life, you should see a doctor at the first symptoms of gangrene.

Common places of localization of the disease are legs, arms, trunk, face, as well as lungs, intestines, appendix. Depending on the diagnosis, a treatment strategy is formed, the prognosis of the patient's recovery is determined.

Content:

• Gangrene classification
• Causes of gangrene depending on the species
• Symptoms of the main types of gangrene
• Diagnosis of gangrene
• Gangrene treatment
• Disease prognosis

Gangrene classification

Types of gangrene depending on the nature of the damage:

• Dry gangrene - the affected area is clearly limited, the pathological process does not spread further. The diseased part of the body takes on a “mummified” appearance - the tissue shrinks, becomes denser, and loses moisture. This type of disease has the most favorable prognosis.
• Wet gangrene - decay processes take place in the tissue, the cellulose swells, softens, and acquires an unpleasant odor.
• Gas (anaerobic, or airless) gangrene is a type of wet form, it is provoked by pathogenic bacteria - clostridia. This type of disease is very dangerous, since the process quickly captures healthy tissues, and the body suffers from severe intoxication.
• Bedsore - develops in soft tissues, on the skin and in the subcutaneous tissue due to prolonged pressure on the same place. It occurs in bedridden patients who do not change body position for a long time.

Another type of gangrene - noma - is formed in children with congenital immunodeficiency who have had a serious infection or somatic illness. With this type of gangrene, the tissues of the face (lips, cheeks, gums, fatty tissue) die. The outcome of this form of the disease is the death of the patient.

Causes of gangrene depending on the species

Gangrene can be caused by internal or external factors. Severe bruises with rupture of blood vessels and damage to nerve endings, exposure to high or low temperatures, radiation damage, the effect of chemicals - all these factors are external causes of gangrene.

Internal processes such as arterial sclerosis, which can cause a heart attack, or blood clots, lead to poor circulation and are internal causes of gangrene. If microbes take part in the development of gangrene, then this is a septic or putrefactive disease. If microbes do not participate in this process, then the disease is aseptic.

There is a strong belief that gangrene can be the result of trauma or gunshot wounds. In addition to these reasons, it is caused by blockage of blood vessels by blood clots or cholesterol plaques, nerve damage, complications of infectious diseases. An accurate diagnosis is impossible without establishing the cause of the gangrene.

Gangrene type	The reasons	Localization area
Dry	Thrombosis of the femoral or popliteal artery, causing gangrene of the legs; Thrombosis of the brachial artery, which caused gangrene of the hands; Vibration disease, which disrupts tissue nutrition, damage to the nerves of the extremities; Raynaud's disease - destruction of blood vessels and nerves of the extremities; Polyneuropathy - damage to the hands or feet due to a violation of innervation; Typhus - affection of the lateral parts of the body	Skin, parts of hands and feet
Wet	Infringement of a hernia, forming intestinal gangrene; Deep frostbite or burn; Untreated appendicitis, cholecystitis; Thrombosis of the mesenteric arteries; Pneumonia complicated by gangrene of the lung; Diabetic foot arising against the background of impaired blood supply	More often feet of extremities, less often lungs, intestines, gall bladder
Gas	Infection of a deep wound with anaerobic bacteria when combined with the following conditions: the depth of the wound reaches the muscle layer, adipose tissue; tissues are poorly supplied with oxygen; the flow of oxygen into the wound cavity is limited due to its closure	The onset of the disease is the skin, muscles, subcutaneous tissue of the limbs, then the pathology spreads throughout the body
Bedsore	There is already 4-5 days of pressure on the tissue, the appearance is complicated by diseases: liver failure; renal failure; cardiogenic shock; malignant tumor.	Scapula, sacrum, spine, hip joints
Noma	Complication of infectious diseases (rubella, measles, meningitis) in combination with impaired immunity	Facial tissues, gums, deep subcutaneous tissue

The definition of symptoms helps to accurately classify the type of gangrene, to determine the tactics of treatment.

Symptoms of the main types of gangrene

Even a few hours late with treatment can lead to death. It is important to timely distinguish and assess the severity of the symptoms of the disease, the rate at which it spreads throughout the body. Distinguish between local symptoms and general signs of intoxication (hyperthermia, weakness, loss of consciousness or its impairment).

Gangrene can affect both a part of the body and an entire organ. The symptom of gangrene is that the affected area changes color, turning blue or even black. Also, gangrene can appear when oxygen is disrupted or stopped. Gangrene develops most easily in tissues located far from the heart. And these areas of the body, first of all, include the lower limbs.

Dry gangrene symptoms

Dry gangrene usually affects a specific area of the body and does not spread further. At the first stage of the development of this disease, a person feels severe pain in the place of a dead vessel, after which the diseased limb turns pale, in the affected area the skin becomes "marble", becomes noticeably colder, the pulsation in this place disappears. Further, the limb completely loses its sensitivity. Pain torments a person for a long time, since the nerve endings in the affected tissues do not die off immediately. There is a violation of blood circulation in the main vessel and in its branches.

Dry gangrene is caused by the difficulty of blood circulation in the limbs, that is, in the arms or legs, or severe tissue dehydration. In this case, parts of the body dry out, then mummify and change color.

There are effective techniques for determining circulatory disorders:

• Raise your arms up, alternately bend your hands. If there is a violation of the patency of the arteries, pain, "goose bumps", weakness will appear in the hands.
• In the supine position, raise your legs at an angle of 45 °, symptoms similar to those in the hands will appear. In addition, with impaired blood circulation or at the initial stage of the disease, it will be very difficult to keep the legs in a given position for more than 25 seconds.

When an artery is blocked, signs of necrosis, or tissue death, begin to appear. The leg or arm takes on a characteristic appearance.

Necrosis symptoms:

• The limb tissues turn black. This symptom is characteristic exclusively for this form of gangrene, because in other forms of the disease, with the exception of noma, parts of the body take on an earthy green or bluish color.
• The affected limb decreases in volume, the symptom is detected when measured in comparison with the same part of the symmetrical limb.
• The limb becomes dry, the sweat in the affected part of the body does not separate.
• Due to the loss of fluid, the tissues of the limbs become denser.
• Nails and hair on the affected area stop growing.

Because the nerve endings die off, no pain is felt in the affected limb. The body's defense system creates a barrier against the spread of the gangrenous process, therefore, intoxication does not occur, there is a clear border between the diseased and healthy part of the limb.

Dry gangrene spreads from the tips of the capillary vessels to the main vein. A protective barrier is formed in the area of connection of the dead tissue with a healthy part of the body. The complete necrosis of tissues and the recovery process takes a long time. During this period, microbes that have entered the focus of the disease can cause the development of another type of gangrene - wet.

With dry gangrene, dead tissues do not decompose as they do with wet ones, and toxic substances penetrate into the blood in very small quantities, so their accumulation does not cause severe intoxication. The patient's state of health during this period is quite satisfactory. This makes it possible not to perform an immediate operation to remove the limb, but to allow the protective barrier to be fully formed.

In exceptional cases, tissues affected by dry gangrene spontaneously separate from the body, and recovery occurs. Unfortunately, this does not always happen, more often the pathological focus remains. Therefore, when the first signs of the disease appear, you should immediately consult a doctor.

Find out more: Dry gangrene - causes, symptoms and treatment

Wet gangrene symptoms

Wet gangrene develops for the same reason as dry gangrene. However, in the first case, a faster process of circulatory disorders in the vessels occurs. Wet gangrene most often affects overweight people. Tissues with this disease are not completely dehydrated, and therefore the decay process begins. With wet gangrene, extensive intoxication of the body occurs due to the fact that a lot of decomposition products penetrate into the blood. In dead tissues, bacteria are actively developing, due to which the disease progresses very intensively. This form of the disease affects not only the limbs, but also the internal organs.

The cause of the development of wet gangrene can be disturbances in the functioning of the intestines, gallbladder or lungs. Blood clots in large veins can also cause wet gangrene.

The initial stage of the disease is very similar to dry gangrene. Only with a wet variety on the affected area, the skin becomes covered with spots, blisters with purulent contents. The patient feels very bad, the affected area hurts badly, the pressure decreases, the tongue is dry, the body temperature rises.

Local symptoms:

• The affected area of the limb becomes dark purple or bluish-purple.
• There is no clear border between healthy and diseased tissue, because the body is unable to delay the spread of pathogenic microbes.
• In the transition zone between the healthy and the affected areas, there is hyperemia, an increase in local temperature, and pain.
• There is a pronounced putrid smell.
• The limb is edematous, pastiness is observed.
• Due to irritation of the receptors, constant sharp pain is felt.
• The local temperature is reduced on the dead tissue.

Intoxication of the body due to wet gangrene poses a serious threat to human life, sepsis may develop, which will cause death. Patients with diabetes mellitus are very difficult to tolerate the disease, since due to the large amount of sugar in the blood, the body cannot fully fight the disease.

With severe diabetes mellitus, there are similar symptoms of vascular lesions. Any wound becomes an entrance gate for infection, and reduced immunity leads to the development of gangrene. To prevent such a development of events, the smallest wounds should be treated with antiseptics (Fukortsin, "brilliant green", Levomekol), protected with sterile dressings and a bactericidal plaster. In case of difficulties with wound healing, you should consult a doctor no later than 1-2 days.

If a patient is diagnosed with a noma or the transition of a gangrenous process to internal organs, general symptoms arise. They are non-specific because they are found in many severe infectious diseases.

Common symptoms of wet gangrene:

• Hyperthermia, reaching 38-39 °, with the addition of peritonitis - up to 40 °;
• Increased sweating;
• Weakness, fatigue;
• Nausea, dizziness;
• Convulsions with gangrene in children whose immunity does not cope with the disease.

In older people, all symptoms can be smoothed out due to an inadequate reaction of the body.

Find out more: Wet gangrene - causes, symptoms and treatment

Symptoms of anaerobic (gas) gangrene

Airless, or anaerobic gangrene, has the worst prognosis. It is caused by clostridia - anaerobic bacteria, putrefactive microorganisms that actively grow on dead tissues without oxygen access. Clostridia secrete a large amount of toxins into a closed wound, destroying the skin, fatty tissue, and muscles in their habitat. Pathogens intensively spread along the limb, releasing decay products into the patient's body.

Anaerobic gangrene symptoms:

• The skin is pale, its temperature is lowered;
• There are blue or reddish spots around the wound;
• The tissues are swollen and pasty, the swelling increases all the time;
• The discharge from the wound is cloudy, offensive, green or brown;
• The exposed muscles resemble cooked meat, they are pale, their fibers are stratified;
• On palpation of the affected limb, crepitus (crunch) is noted, the symptom is characteristic only for anaerobic gangrene.

Gas gangrene destroys muscle tissue in the body. After getting there, where there is a favorable environment for the development of microbes, they begin to release toxic substances, which, penetrating into the connective tissues, destroy their cells. This process is quite rapid. Microbes produce compounds that promote the breakdown of proteins and carbohydrates in the affected tissues with the release of a special gas.

The initial symptoms of anaerobic gangrene are soreness and swelling in the area of infection. Further, a dark liquid with a bad smell begins to stand out from the wound, the skin around the wound darkens. When lightly touching the skin in the wound area, a crackling sound is heard.

Unfortunately, this type of gangrene cannot be cured without surgery. The entire affected area is removed, in the most advanced cases they resort to amputation of a limb with a focus of the disease.

To diagnose puffiness, the Melnikov symptom is used. A thread or a strip of tissue is loosely wound on the affected limb, leaving a gap between the bandage and the limb of 1-2 cm. If after a few hours the knot cuts tightly into the tissue, the swelling increases, which is typical for the anaerobic form of the disease.

The general symptoms of anaerobic gangrene are in many cases fatal to the patient. Intoxication with the waste products of clostridia is fatal.

Common symptoms of gas gangrene:

• Loss of ability to move, weakness;
• Severe hyperthermia, reaching 39-41 °;
• Loss of consciousness, hallucinations, delirium;
• Nausea and vomiting that does not relieve the condition;
• Falling blood pressure below 100/70 mm Hg. Art., an even more pronounced decrease (by 30 mm Hg) is an extremely unfavorable sign;
• Tachycardia up to 100-120 beats per minute, felt by the patient.

Clostridium toxins affect the brain, kidneys, and liver. Untimely medical care can lead to death from intoxication.

Find out more: Gas gangrene - symptoms, forms and treatments

Symptoms of gangrene-bedsore

The process develops gradually, starting with blanching of the skin in the area that is under pressure. There is a decrease in the sensitivity of the skin to pain and temperature changes. On the second or third day, edema of the subcutaneous tissue begins, the skin becomes brown.

How to prevent pressure ulcers:

• To reduce the pressure on the tissues, the lying patient should be encouraged to move: turn him from side to side, if possible, move him to a sitting position;
• Massage problem areas regularly (between the shoulder blades, on the sacrum, along the spine);
• Use anti-decubitus mattresses.

Without treatment, an infectious process joins the symptoms of a pressure sore, which is expressed by hyperthermia, weakness, nausea, and increased sweating.

Find out more: Pressure ulcers in bedridden patients - risk and stages of pressure ulcers

Diagnosis of gangrene

Visual examination and analysis of the patient's complaints in most cases is sufficient to establish a diagnosis.

To clarify the nature of gangrene and determine the sensitivity of pathogenic bacteria to antibiotics, the doctor prescribes laboratory tests:

• Complete blood count - a decrease in the level of leukocytes below 4 * 10 ⁹ / l is a sign of decreased immunity;
• Biochemical blood test - can detect the onset of renal failure;
• General urine analysis - with anaerobic gangrene, protein or glucose appears in the urine;
• Bacterial inoculation from the affected area - performed within a week;
• Bethe test - used to determine the type of gangrene, for this they take a piece of tissue from the gangrenous area and place it in 4-6% sodium chloride solution, the emergence of the sample is a sign of anaerobic gangrene.

The results of X-ray examination of the affected limb are interpreted in the same way. Gas bubbles in the picture are a sign of anaerobic gangrene.

Gangrene treatment

The most effective treatment for gangrene of the extremities is surgery. The hand or shin of a leg affected by dry or wet gangrene is amputated. In case of intoxication with the waste products of pathogenic bacteria, antibacterial drugs or an infusion of crystalloids are prescribed:

• Ringer's solution;
• 0.9% sodium chloride solution.

These universal tools cover most types of pathogens, since there is often no time for differential diagnosis.

Naturally, the doctor seeks to preserve the limb whenever possible.

Treatment of gas gangrene of the legs takes place in several stages:

• All dead tissue is removed.
• "Stripe" cuts are performed along the skin and fatty tissue for a constant supply of air and reduction of the growth of pathogenic bacteria.
• Prescribe several antibiotics, anti-gangrenous serum.
• Intravenous infusion of crystalloids up to 4-5 l / day is performed.

Ineffective treatment of gas gangrene of the extremities is completed with amputation, provided that the disease has not spread to the patient's trunk.

Disease prognosis

Even with a favorable prognosis for the course of dry and wet gangrene, the disease ends with amputation of the limb and the patient's disability. The outcome of the noma in 90-95% of cases due to significant intoxication is the death of the patient. With gas gangrene in 30-40%, death occurs due to damage to internal organs.

Complications of the disease involving the gallbladder or appendix have a favorable prognosis. After surgery on the affected intestine, you have to follow a diet and take medications throughout your life. Complications in the lung force the patient to constantly suffer from shortness of breath, respiratory failure.

Cured gangrene does not affect life expectancy, but its complications worsen the quality of life. For adequate prevention of gangrene, it is necessary to immediately treat any wound with an antiseptic and seek medical help. Even with adequate treatment of gangrene, death or injury to the patient is possible. This likelihood increases when children become ill with gangrene, patients with weak immunity, and when they see a doctor too late.

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.