Gangrene
Dr. Assad Adnan Sabri
FICMS-GIT Gastrointestinal Surgery (subspecialty )
FICMS General Surgery
CABS General Surgery
Consultant General and Laparoscopic Surgeon
Origin of Gangrene
The word "gangrene" comes from the Greek
"ganggraina" denoting
"an eating sore that ends in mortification".
MEDICAL DEFFINITION:
Gangrene: The death of body tissue due
to the loss of blood supply to that tissue,
sometimes permitting bacteria to invade
it and accelerate its decay.
Gangrene is a complication of necrosis “
N cell death N ” characterized by the
decay of body tissues, which become
black and appearing “rotten”.
It is caused by infection or ischemia.
GANGRENE
It is usually the result of critically insufficient blood
supply.
Often associated with diabetes and long-term
smoking.
Condition is most common in the lower
extremities.
Blood supply when cut off
Tissues will die
Classification
It can be classified into two types
according to the cause of the tissue
necrosis:
• Primary gangrene
• Secondary gangrene
Primary gangrene
It is brought by infection with pathogenic
bacteria which both
kill the tissue by secreting exotoxins and
Then invade &digest the dead tissue.
Gas Gangrene
Secondary gangrene
This type of gangrene is characterized by
necrosis due to some other causes,
usually loss of blood supply from vascular
obstruction or tissue laceration and
saprophytic bacteria then digest the dead
tissue,
There are two types :
Dry gangrene
Wet gangrene
TYPES OF GANGRENE
DRY GANGRENE
Secondary
WET GANGRENE
GAS GANGRENE Primary
DRY GANGRENE
Dry gangrene begins at the distal part of
the limb due to ischemia and often occurs
in the toes and feet of elderly patients
due to arteriosclerosis.
DRY GANGRENE
Dry gangrene spreads slowly until it
reaches the point where the blood supply
is inadequate to keep tissue viable.
Theaffected part is dry, shrunken and
dark black, resembling mummified flesh.
DRY GANGRENE
People with impaired peripheral blood
flow, such as diabetics, are at greater risk
of contracting dry gangrene.
DRY GANGRENE
The early signs are a dull ache and
sensation of coldness in the affected area.
If caught early, the process can sometimes
be reversed by vascular surgery.
If necrosis sets in, the affected tissue
must be removed and treated like a case
of wet gangrene.
Dry gangrene
Due to gradual cut of blood supply.
The line of demarcation between dead
and living tissue is clear.
The lesion remains localized.
Dry Gangrene
affects bodies extremities
1. arteries get blocked= tissue slowly dies
2.Affected body parts feel cold and turn dark, it will dry
and eventually falling off
3.Mostly affects extremities such as fingers and toes
DRY GANGRENE
DRY GANGRENE
DRY GANGRENE
YUCKY!!!
WET GANGRENE
Itoccurs in internal organs where
moisture and temperature are favorable
for bacterial growth
Death occurs rapidly from septicemia,
toxemia and shock
WET GANGRENE
Wet gangrene occurs in naturally moist
tissue and organs such as the mouth,
bowel, lungs, cervix, and vulva.
WET GANGRENE
In intestine:
Gangrene occurs due to
malpositions e.g. volvulus, hernia and
intussusceptions
Necrosis is due to venous obstruction
and congestion
Presence of bacteria in the intestine
allows rapid spread of moist gangrene
WET GANGRENE
Bedsores occurring on body parts such as
the sacrum, buttocks and heels (not in
“moist” areas) are also categorized as wet
gangrene infections.
WET GANGRENE
Thetoxic products formed by bacteria are
absorbed causing systemic manifestation of
bacteremia and finally death.
Theaffected part is soft, putrid, rotten
and dark.
The darkness in wet gangrene occurs due
to the same mechanism as in dry gangrene.
Wet gangrene
The infected tissue are edematous due to
large amount of subcutaneous fluid.
The demarcation between dead and living
is indistinct.
May extend proximally beyond the site
of infection.Wet gangrene is seen in the
bowel due to mesenteric vascular
occlusion and in diabetic limb.
Wet Gangrene
occurs with injury and infection
1.Injury restricts blood flow to the certain area
2.Blood cant flow to tissue so can’t fight infection=
infection sets in,
3.Swelling from infection= even less blood flow= fast
spreading gangrene=life threatening
4.Become swollen, discolored, and smelly.
WET GANGREEN
WET GANGRENE
GAS GANGRENE
Gas gangrene is a bacterial infection that
produces gas within tissues.
Itis a N deadly N form of gangrene
usually caused by bacteria.
Infection spreads rapidly
as the gases
produced by bacteria expand and affect
healthy tissue.
GAS GANGRENE
Gas gangrene is caused by a
environmental bacteria.
These Bacteria are mostly found in soil.
These environmental bacteria enter the
muscle through a wound and cause
necrosis of tissue and powerful toxins.
GAS GANGRENE
These toxins destroy nearby tissue,
generating gas at the same time.
Gas gangrene can cause necrosis, gas
production, and sepsis.
Progression to toxemia and shock is often
very rapid.
Because of its ability to quickly spread to
surrounding tissues, gas gangrene should
be treated as a medical emergency.
GAS GANENE
These are fatal disease conditions caused
by different species of spore forming
bacteria- Clostridium (C. septicum, C.
perfringens)
These organisms are anaerobic, spore
forming, soil inhabitant and cause diseases
as wound infections.
GAS GANGRENE
Under anaerobic conditions the
organisms multiply, produce toxins causing
tissue digestion like lecithinase and
collagenase
The organisms produce edema and gas in
the affected tissues and spread to
surrounding tissues
GAS GANENE
GAS GANGRENE
GAS GANGRENE
GAS GANGRENE
SPECIFIC GANGRENES
Noma is a gangrene of the face.
Necrotizing fasciitis affects the deeper
layers of the skin.
Fournier gangrene usually affects the
male genitals.
NOMA
Is a gangrenous disease leading to tissue
destruction of the face, especially the
mouth and cheek.
Risk factors include severe protein mal
nutrition and unsanitary conditions.
NOMA
NECROTIZING FASCIITIS
Commonly known as flesh-eating
disease or flesh-eating bacteria.
Rare infection of the deeper layers of
skin and easily spread within the
subcutaneous tissue
NECROTIZING FASCIITIS
NECROTIZING FASCIITIS
FOURNIER GANGRENE
A type of necrotizing infection usually
affecting the male genitals.
In the majority of cases it is a mixed
infection caused by both aerobic and
anaerobic bacteria
FOURNIER GANGRENE
FOURNIER GANGRENE
FOURNIER GANGRENE
OUCH!!!
TREATMENT
Usuallysurgical with amputation
necessary in many cases.
Antibiotics alone are not effective
because they do not penetrate ischemic
muscles sufficiently.
TREATMENT
The best treatment for gangrene is
revascularization and restoration of
blood flow to the affected area.
Can reverse some of the effects of
necrosis and allow healing.
The method of treatment is generally
determined depending on location of
affected tissue and extent of tissue loss.
Results of necrosis and gangrene
Necrosis may terminate in several ways:
1. Liquefaction and removal by neutrophils,
lymph or blood- (small areas)
2. Liquefaction and cyst formation- (large areas).
Fibrous capsule may be formed
3. Liquefaction , abscess formation and
discharge- (invasion by pyogenic bacteria)
4. Encapsulation without liquefaction-
(coagulation and caseous necrosis)
Results of necrosis and gangrene
5. Sloughing and desquamation- (on
external surfaces)
6. Organization of necrotic tissue
7. Dystrophic calcification
8- Death of the human – usually in case of
moist gangrene
Thank you
