Definition
The gangrene is a Nécrose fabrics.
It is caused by an arterial obstruction by Embolie, Choc, Infection or by the exposure to an intense cold. Its origin is generally related to the prolonged interruption or the extreme deceleration of the blood irrigation. In the absence of contribution of Oxygen, the fabrics die, then putrefy.
The stop of blood circulation in a fabric is always accidental.
Etymology of the word
Gangrène comes from the Latin gangraena and the Greek gagraina (γάγγραινα), which means the putrefaction of fabrics.
Origin
The first appearance of the term seems to be in England in XVIe century and Shakespeare quotes it in a worm of Coriolan : The service off the foote Being ounce gangren' D, is not then respected For what it was before .
The diagnosis
The diagnosis of a gangrene is generally simple and fast. A general practitioner, a Dermatologist or a Chirurgie N can easily draw up a diagnosis. In case of doubt, the doctor will carry out a Blood test, an analysis of fabric or liquid contained in the Cloque S.
In order to confirm the diagnosis, the doctor can ask for a setting in culture of the germs but it will not await the results of these analyzes to begin the treatment.
If a member or part of the body becomes pale and cold, and remains in this state more than two hours or if a Doigt or a Orteil does not heal in less than one week, it is recommended to consult a Médecin urgently.
Types of gangrene
The types of gangrene are very numerous, it is impossible to quote them all.
Principal types
- the gangrene dries occurs following the obstruction or of the Sclérose of one or more blood-vessels, generally a Artérite, a Embolie or a Thrombose. It is characterized by the appearance of fabrics of dark color, generally blacks and desiccated.
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the white or milky gangrene occurs following a suspension or durable of blood circulation. It is characterized by the appearance of fabrics of white color, near to the color of milk.
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the wet gangrene generally occurs on a dry gangrene or after a bacterial infection. It is characterized by a swelling and a decomposition of fabrics accompanied by a seepage and an increasingly abundant putrefaction.
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the gas gangrene is characterized by a microbial infection with anaerobic germs (like Clostridium perfringens of a) type, and a production of gas within infected fabric. This one is declared after stain of the wounds by ground, instruments or dirty Main S. It results from it a feeling of crackling, sometimes perceptible when the zones concerned are palpated. These infections are frequent on wounds of war; on our premises, they contract, also, after contamination at the time of a Surgical operation. They remain serious in spite of the Antibiotique S and the use of the oxygen treatment hyperbare.
Other types of gangrene
- Gangrène dermic acute also called fasciite necrosing or gangrene of streptococcic origin is due to a Infection by a Streptocoque of group A.
- Gangrène hospital
- Gangrène de Lasègue: gangrene of the Bronchus S and the Lung S, characterized by a strong odor of the expectorations and breath.
- symmetrical Gangrène of the ends: consecutive gangrene with the dead hand (disorders of the Circulation, generally, with the ends of the Finger S).
- Gangrène de Fournier: gangrene which is characterized by a swelling of the Scrotum.
- Gangrène diabetic: at a diabetic, the gangrene is characterized by lesions on the level of the cutaneous terminations.
- pulmonary Gangrène: gangrene which reaches pulmonary fabrics, generally causes death.
- senile Gangrène: gangrene which reaches the elderly.
Symptoms
In general, in all the types of gangrene, the first Symptôme is a loss of the Sensibilité and Mobilité. The zone reached becomes cold, takes a dark coloring gradually and finally, necroses.
The gangrenés fabrics are frequently prone to bacterial superinfections and when they are infected too much; a gas gangrene appears. In the case of a gas gangrene, the incubation period is from 18 to 36 hours. Very quickly, of the bubbles filled with a purple liquid appear. The multiplication of the germs involves an significant amount of gas whose odor is nauseous. With palpation, one hears a crackling due to the gas bubbles. Then, the skin weakens and becomes maroon or even black. The victim sees its Température strongly rising and suffers from intense pain. Its Cardiac rhythm increases. The patient is very tired and its Blood-pressure decreases. It can sink in the Coma and even die.
The most exposed parts of the body
The gangrene can reach all the parts of the body but the most touched zones are the ends like the foot S or the Jambe S, the Main S, the Doigt S, the Orteil S.
However, the Internal organ S like the Lung S, the Internal S, the Liver,… can also be reached.
Appearance of the disease
The gangrene never develops on a healthy skin, it can appear in the following cases:
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a Wound
- a scratch slightly deeper than usually
- a Hémorroïde
- a Diverticule
- a anal Fissure
- a rupture of the Urètre
- Certaines diseases facilitate the appearance of gangrene like the diabetes
- a Angiopathie
- a Surgical operation
- a wound following the penetration of an object in the Abdomen
- a Contusion
- a Ulcère
- a Abcès
Contagion
The gangrene is not contagious, insofar as it does not transmit a person to another. She is not either congenital, Héréditaire; she is not transmitted of a relative to a child, before the birth.
On the other hand, one can say that this disease is propagated quickly if one does not act. For example, at the beginning of a Toe, it can extend to the foot, then with the Jambe.
Treatments
The gangrene develops quickly. A beginning of gangrene can be stopped and one can hope for a more or less complete repair of fabrics, with a progressive elimination of destroyed fabrics. The Antibiotic only, are not generally sufficient to cure.
There exist three great principles to stop it:
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Initially, the antibiotic catch slows down the infection. Those fight against the bacteria.
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Then, the intervention of a surgeon who will remove infected or dead fabrics, to stop the propagation; this stage is also very important and generally makes it possible to avoid the amputation, when it is about a member.
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Lastly, by the oxygen treatment hyperbare, the patient is placed in a box, a metal cistern sealed and filled with Oxygène to high pressure. The pressure forces oxygen to penetrate in fabrics in order to stop the propagation of the bacteria.
Today, the Antibiotic S and the Chirurgie are most often used and are most effective. Currently, 80% of the victims of gangrene survives .
Preventive measures
The regular care and the cleaning of the wounds, using disinfectant, are generally enough to avoid the appearance of gangrene.
There do not exist vaccines, nor of preventive medications. However, good a Hygiene, the consultation of a general doctor as of the first suspect signs could avoid or at least avoid a propagation of this disease.
It is also recommended to keep the hands and the feet with the heat and to avoid carrying tight shoes.
The elderly, the people diabetics, and the people suffering from a bad circulation must also be very vigilant when they have Infection S with the foot S and the Main S.
Frequency
The developed countries are touched but the Africa still has many cases each year. The gangrene is badly known and still causes a certain fear nowadays. At the time of Catastrophe S, of Flood S,… one observes a recrudescence of case, even in the developed countries. In the Western company, the patients developing most frequently gangrene are diabetics or reached Artériosclérose. Indeed, their arteries are stopped more easily, which involves sometimes a gangrene.
A Fatal disease
The gas gangrene is that which generally involves the Mort. Indeed, if the Infection is not stopped, the toxins reach the Sang and contaminate the vital bodies.
The other types of gangrene look after in the developed Pays.
Repair
It happens that parts of skin are destroyed and that one practices Clerc's Offices of skin. The prostheses, they, ensure the replacement of a member amputee.
The Asticothérapie makes it possible to destroy the cells died by leaving the intact alive cells.
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