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Shuja Tahir
Faisalabad, Pakistan IR-024
Surgery
GANGRENE
G angrene is the death (massive
necrosis) of macroscopic part of
the tissue with super-imposed
!
!
!
Streptococcal infection.
Bacteroides infection.
Mixed infection.
putrefaction.
TRAUMA
ETIOLOGY The injured tissue leads to loss of blood
It is caused by the tissue ischaemia supply and death of major part of distal
secondary to following conditions : tissue in following conditions ;
! Crush injuries.
ARTERIAL OBSTRUCTION ! Pressure sores.
Acute or chronic obstruction to the flow ! Circumferential burns.
of arterial blood leads to gangrene
formation. VENOUS OBSTRUCTION
The common diseases causing venous
The arterial obstruction occurs due to ; obstruction and gangrene are ;
! Atherosclerosis. ! Polycythemia.
! Thrombosis. ! Pancreatic neoplasms.
! Embolus (from atrial fibrillation). ! Trousseau's syndrome.
! Post diabetic neuropathic arteritis.
! Constriction ring of strangulated These may lead to peripheral venous
loops of bowel in volvulus and thrombosis which leads to retrograde
strangulated hernias. arterial obstruction and gangrene
! Buerger's disease (thrombo-angitis formation.
obliterans).
! Raynaud's disease. TYPES OF GANGRENE
! Cervical rib. Following clinical varieties of the
! Ergot poisoning. gangrene are seen ;
! Tourniquets, tight plaster and ! Dry gangrene.
bandages. ! Moist or wet gangrene.
! Intra arterial injection of ! Gas gangrene.
thiopentone or sclerosing ! Infective gangrene.
substances. ! Carbuncle.
! Meleney's synergistic gangrene.
INFECTION ! Fournier's gangrene.
The anaerobic infections may lead to ! Cancrum oris and noma
various types of gangrene. vulvae.
Following organisms commonly cause
2
the infections leading to gangrene ; DRY GANGRENE
! Clostridial infection. This is not true gangrene and should be
! Non clostridial anaerobic called mummification. There is massive
infection. necrosis but putrefaction is almost
! Staphylococcal infection. negligible. Although putrefactive
REFERENCES
1. John Saunders Franz Von. Lichtenberg. gangrene. Report of three cases and
Infectious disease. Robbins pathologic review of the literature. Acta urologica
basic of disease. Cotran, Kumar, Robbins Balgica. [JC: 26y]. 1990; 58(2):161-70.
5th edition WB Saunders company
London. 1994; 338-339. 5. Lucca M. Unger AD. Deveuny AM.
Treatment of fournier's gangrene with
2. RE. Condon. Dietmar H. Withmann. adjunctive hyperbaric oxygen. American
Surgical infection. Peter J. Moris and journal of emergency medicine. [JC:aa2].
Ronall A. Malt . Oxford text book of Sep 1990; 8(5):385-7.
surgery. Oxford medical publication.
1994; 34-35. 6. Tork L. Kozepessy L. Uraemic gangrene
syndrome. Acta dermato-venercologica.
3. A Cuschieri.H. Gilles. Specific infections of [JC:Omg]. 1991; 71(5):455-7.
surgical importance. In essential surgical
practice. A. cuschieri GR. Giles AR. 7. Cole HG. Neloon RL. Peters MS.
Moosa. Butterworth Heinam. Third Pyoderma gangrenosum and
edition. 1995; 262-267. adrenocortical carcinoma cutis. [JC: dxb].
Sep 1989; 44(3):205-8.
4. Van Brien P. Mallelaer J. Ballist I. Fournier's
SUMMARY
Gangrene ! Moist or wet gangrene
Etiology ! Gas gangrene
The author : ! Arterial obstruction ! Infective gangrene
Muhammad Shuja Tahir ! Infection ! Carbunci gangrene
FRCS (Ed), FCPS (Hon)
is professor and head of the ! Trauma ! Meleney’s synergistic gangrene
department of Surgery at ! Venous obstruction ! Fournier’s gangrene
Independent Medical ! Cancrum oris and noma vulvae
College Faisalabad. Types
shuja@iu-hospital.com ! Dry gangrene