Gangrene

 

Gangrene

Aim of examination

Gangrene or not?

What is the cause?

Demarcated or not?

Which type?

Cardinal signs (Gangrene or not?)

Oh! Press and see how color fades

Oh! Odor

Press Pulse: Loss of pulsation and Sluggish capillary circulation

See Sensation Loss of sensation

How Heat Loss of heat

Colour Color Fixed color changes / Blue and later black

Fades Function Loss of function

What is the cause?

Traumatic Direct trauma Crushing

  • Pressure ‘bed sores’
  • Indirect trauma Injury of main vessel
  • Delayed Vascular repair after tissue death

Physicochemical

  • Burn
  • Frost-bite
  • Trench foot

Infective

Specific Clostridial gas gangrene

Non specific:

  • Carbuncle (Skin)
  • Anaerobic cellulitis (Skin)
  • Cancrum iris (Mouth)
  • Noma vulvae (Vulva)
  • Phegendena (Breast)
  • Melenery’s ulcer (Perineum and abdominal wall)
  • Fournier syndrome (Scrotum)

Arterial

  • Thrombosis Atherosclerosis
  • Diabetes
  • Beurger’s disease
  • Artritis
  • Embolic
  • Vasospastic Raynaud’s disease
  • Ergotism

Venous Major outflow obstruction

Neuropathic

  • Diabetes
  • Syringomyelitis
  • Leprosy

Demarcated or not?

Demarcation

    • Depend on (VascularityInfectionTrauma)
    • Stages (Zone of demarcationLine of demarcationPlane of demarcation)
    • Line of demarcation should be (Complete ‘all around’Well definedConstant place)
    • Plane of separation may be
      • Ulceration at the expense of dead tissue ‘depth’
      • Suppurative at the expense of living tissue ‘abrupt stop’
    • Failure of demarcation (In continuity – Skip lesions – Dye back phenomenon)

Which type?

Moist vs. Dry

  • Swollen  vs. Shrunken
  • Stretched skin   vs. Wrinkled skin
  • With bullae  vs. No bullae
  • Soft  vs. Hard
  • Less dark  vs. Darker in color
  • Less odor  vs. With characteristic odor
  • May be septic or aseptic

Causes of Moist Gangrene 

  • Sudden arterial obstruction
  • Venous obstruction
  • Generalized edema
  • Liquefaction of tissues