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Gangrene

is a form of localized tissue or organ death (necrosis) from the prolonged blockage of blood-supply to the tissue. Gangrene can occur in the presence of arteriosclerosis, diabetes, a decubitus ulcer, severe burns, or frostbite. Gangrene usually affects the extremities, such as the toes, feet, legs, fingers, hands, and arms, but can also occur in other parts of the body, including the abdomen or intestines. Gangrene usually occurs after trauma or surgery. Usually gangrene begins 24 hours to 3 days after trauma but may occur anywhere from 3 hours to 6 weeks later.

In dry gangrene, the decrease in the blood-supply is gradual, turning the affected part discolored and cold, then dark and dry. Treatment requires improving blood flow. Moist gangrene comes from a sudden blood-supply cutoff. Bacterial infection causes swelling, discoloration, and then a foul smell. Along with antibiotics, tissue removal may be needed to prevent spread, which can be fatal. Gas gangrene is caused by a bacterial infection (generally from clostridium bacteria). Gas bubbles are produced under the skin by a highly lethal toxin from the bacteria, and the wound oozes a brownish, smelly pus. Infection spreads rapidly, causing death. All dead and diseased tissue must be removed and antibiotics given; an antitoxin can also be used.

Symptoms of Gangrene

Areas of either dry or moist gangrene are initially characterized by a red line on the skin that marks the border of the affected tissues. As tissues begin to die, dry gangrene may cause some pain in the early stages, though this may go unnoticed in those individuals with diminished sensation to the affected area. Initially, the area becomes cold, numb, and pale. As the gangrene continues the area changes in color to brown, then black. This dead tissue gradually separate from the healthy tissue and fall off.

In moist and gas gangrene, there is generally a sensation of heaviness in the affected region that is followed by severe pain. The pain is caused by swelling resulting from fluid or gas accumulation in the tissues. This pain peaks, on average, between one to four days following the injury, with a range of eight hours to several weeks. The swollen skin may initially be blistered, red, and warm to the touch before progressing to a bronze, brown, or black color. In approximately 80% of cases, the affected and surrounding tissues produce crackling sounds (crepitus), as a result of gas bubbles accumulating under the skin. The gas may be palpable (felt) beneath the skin. In moist gangrene, the pus is foul-smelling, while in gas gangrene, there is no true pus, just an almost "sweet" smelling watery discharge.

Symptoms of gangrene may include:

  • fever
  • rapid heart rate
  • rapid breathing
  • altered mental state
  • loss of appetite
  • diarrhea
  • vomiting
  • pale skin
  • numbness at the site of the infection
  • severe pain and swelling at the site of injury
  • discoloration of the skin, often starting as white and eventually becoming brownish-reddish or black color
  • a crackling or rubbing sensation under the skin
  • frothy, watery, foul smelling discharge
  • dark and red or black muscles and bones if the skin breaks open
  • decreased activity
  • vascular collapse
Gas gangrene can be a life-threatening condition and requires immediate medical attention.

Diagnosing Gangrene

A diagnosis of gangrene is based on a combination of the patient's history, a physical examination, and the results of blood and other laboratory tests. The patientís history is important for signs of recent trauma, surgery, cancer, or chronic disease. It will also reveal the presence of symptoms such as loss of appetite, diarrhea, and vomiting. The physical examination can indicate signs of infection around wounds, areas of tenderness, as well as fever, a rapid breathing, and a rapid heart rate. Blood tests can be used to determine whether infection is present and to determine the extent to which an infection has spread. A sample of drainage from a wound, or obtained through surgical exploration, can be cultured with oxygen (aerobic) and without oxygen (anaerobic) to identify the microorganism causing the infection and to aid in determining which antibiotic will be most effective. A sample obtained from a patient with gangrene will generally contain few, if any, white blood cells and, when stained (with Gram stain) and examined under the microscope, will show the presence of purple (Gram positive), rod-shaped bacteria. Additional tests, such as x-ray studies and more sophisticated imaging techniques, such as (CT) or (MRI), may identify areas of gas accumulation and muscle death (myonecrosis). A final diagnosis of gas gangrene, however, often requires surgical exploration of the wound. During the procedure, exposed muscle may appear pale, beefy-red, or in the most advanced stages, black. If infected, the muscle will fail to contract with stimulation, and the cut surface will not bleed.

Treating Gangrene

The protocol for the treatment of gangrene depends on the type of gangrene that is present.

Areas of dry gangrene that remain free from infection (aseptic) in the extremities are most often amputated Treatments applied to the wound externally (topically) are generally not effective without adequate blood supply to support wound healing. Assessment by a vascular surgeon, along with x rays to determine blood supply and circulation to the affected area, can help determine whether surgical intervention would be beneficial.

Moist gangrene requires the prompt initiation of intravenous, intramuscular, and/or topical broad-spectrum antibiotic therapy. In addition, the infected tissue must be removed surgically (debridement), and amputation of the affected extremity may be necessary. Pain medications (analgesics) are prescribed to control discomfort. Intravenous fluids and, occasionally, blood transfusions are indicated to counteract shock and replenish red blood cells and electrolytes. Adequate hydration and nutrition are vital to wound healing.

In some cases, treated includes the administration of oxygen under pressure greater than that of the atmosphere (hyperbaric) to the patient in a specially designed chamber.

Treatment may also require pain medication, the use of blood thinners to prevent clotting, the use of physical therapy, and when necessary, prosthetics.

Legal Options

In the United States, approximately 50% of moist gangrene cases are the result of a severe traumatic injury. Among the most common causes are car and industrial accidents, crush injuries, and gunshot wounds. Approximately 40% occur following surgery. Surgeries involving the bile ducts or the intestine are the most frequent procedures causing gangrene. Approximately two-thirds of cases affect the extremities, and the remaining one-third involve the abdominal wall. When a case of gangrene is not diagnosed and treated in a timely fashion, it can result in

  • permanent tissue damage
  • amputation
  • jaundice with liver damage
  • sepsis or blood poisoning
  • shock
  • coma
  • death

If you or someone you love have suffered from gangrene due to the neglect of a physician or other health care provider (such as a hospital, nursing home, or assisted living provider), you should immediately contact a competent attorney. The attorney will work with you to determine the legal options that may be available.




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