Gas gangrene is also known as clostridial myonecrosis. It is a bacterial infection, produces gas in tissues. Gas gangrene is a severe infection and that must be treated as soon as possible. Diabetic gangrene is characterized by the lack of blood flow due to damage to body tissues. It is caused due to infection or injury resulted from inadequate blood supply to the body parts. Moist gangrene associated with diabetes mellitus. Diabetic gangrene generally affects the body parts like toes, fingers, limb but can also affect inside the body like damaging organs and muscles. The complete details of gas gangrene and diabetic gangrene are given below.
A diabetic gangrene is due to 3 factors, e.g.
(1) The diminished resistance of the sugar-laden tissues to trauma and infection – the sugar serves as a medium for the bacteria to grow.
(2) Atherosclerosis, resulting in circulatory impairment.
(3) Trophic changes due to peripheral neuritis. The sensation it impaired and so minor trauma is not appreciated by the patient or is neglected.
Clinically the diabetic gangrene belongs to two distinct groups (1) Dry Gangrene, usually occurring in an elderly diabetic. The second and third factors mentioned above play the most important role in these cases. The gangrene is slowly progressing, and there is usually a line of demarcation. (2) Moist Gangrene, usually superimposed on a trauma of infection in an uncontrolled diabetic, often at the younger age group. The first factor mentioned above plays the most important role in these cases. The gangrene is of spreading type.
Clinical Features of Diabetic Gangrene:
(1) Usually injuries just before the onset of gangrene.
(2) Mostly lower extremity, viz. great toe, heel, septic corn, etc.
(3) Usually males over 50 years.
(4) Features of diabetes mellitus.
(5) Features of moist gangrene- (a) pain, (b) no line of demarcation, (c) extensive sloughing of skin and soft tissue, (d) offensive smell. - (e) inflammatory changes marked(f) rapidly spirals (g) Sugar and acetone may present in urine, blood sugar level is high.
(A) General –
(1) Control of infection by heavy dose of antibiotics,
(2) Control of diabetes by the suitable dose of insulin as estimated by blood sugar and by dietary regulation.
(3) Rest of the part,
(B) Operative –
(1) Saline bath daily. (2) In uncontrolled spreading cases-amputation. (3) Regular dressing (4) Indirect surgery to effect vasodilation, i.e. sympathectomy. – (5) Liberal incisions.(6) Sacrifice part
This is a dangerous wound infection caused by anaerobic gas forming organisms or clostridia. The infection is marked by inflammation, gas formation and necrosis of muscles with severe toxemia.
(A) Predisposing Factor –
(1) Impairment of circulation due to- vascular damage, tight bandaging or plastering prolonged use of tourniquets.
(2) Puerperal sepsis, septic abortion, etc.
(3) Diabetes and pre-existing occlusive arterial diseases.
(4) Lacerated injuries involving muscles.
(5) Inadequate wound excision and poor drainage of wounds.
(6) Secondary invasion by aerobic pyogenic bacteria, which utilize the oxygen.
(B) Exciting factors –
Contamination of the wound by the gas gangrene organisms, viz. (a) Saccharolytic –CI. Septicum, CI. Oedematiens, (b) Proteolytic – CI. Sporogenes.
(1) A collection of liberated gas and fluid between the muscles and their sheaths, which separate the muscles fibers from the sheaths. This causes the further diminution of blood supply to the muscles.
(2) The muscles become swollen, puffy and dull in color, which changes to green, thence to brown and ultimately to black
(3) Extensive necrosis of the muscles.
(4) Microscopically, there is coagulative necrosis with loss of striations in the muscles.
The incubation period is shorts- 24 to 72 hours (or may be less).
(1) Nausea, vomiting may be present.
(2) Pulse is rapid, and there is a quick fall of blood pressure.
(3) Anaemia may be present.
(4) The patient is very toxic.
(5) Facial expression – pale, anxious with blood shot eyes.
(6) Cold, clammy extremities with the collapse of the peripheral veins.
(7) Jaundice and cyanosis are the late feature.
(8) Temperature with rigor.
(9) Dry and brown tongue
(10) Cold, clammy extremities with the collapse of the peripheral veins.
(a) Acute pain in the limbs. (b) Numbness. (c) Swelling and oedema of the part. (d) The skin is yellowish, greenish of black, with putrefactive change. (e) Crepitus, due to gas, is often palpable and sometimes audible through a stethoscope. (f) There is profuse discharge from the wound, which is very offensive smelling. There may be bleb containing these discharges.
(1) An X-ray may show evidence of gas shadows.
(2) Swab test – for bacteriological examination- this is important – (a) to confirm the diagnosis, (b) to know which group of clostridia is predominant so that the specific serum may be prescribed.
Bad. Mostly fatal.
(A) Prophylaxis –
(1) Avoiding use of tourniquets during wound excision.
(2) Penicillin in large and frequent doses to be given.
(3) Anti-gas gangrene serum/A.T.S. etc. to be given immediately
(4) Meticulous wound excision, with the removal of – all foreign bodies, all devitalized tissues or blood clots, all dead and damaged muscles.
(5) Active treatment for diabetes in the known diabetic patient.
(6) Anti-gas gangrene serum/A.T.S. etc. to be given immediately
(B) Curative –
(2) Serum and anti-bacterial agent etc.
(3) Operative Amputation.
(4) The wound should be opened up and exposed to air.
(6) Oxygen inhalation, if necessary.
Causes of Death:
(1) Shock. (2) Involvement of vital organs.
Home Remedies for Gangrene
1) Butchers herb is a plant that is good for circulation; it helps in relieving gangrene pain.
2) Compress, baths, and Soakings are useful
3) Eat beans and legumes
4) Eat more vegetables
5) Drink lots of water
6) Avoid pork, shellfish & lobsters