GANGRENE

Definition of gangrene

Gangrene (or gangrene) is a pathological condition characterized by the literal massive putrefaction of one or more body tissues. This is a terribly worrying clinical urgency because - due to the lack of blood flow - the tissue affected by gangrene inevitably goes to death (tissue necrosis). Often, due to insufficient blood supply, the tissue affected by gangrene is then rapidly invaded by bacteria.
Although generally manifesting itself in the extremities of the body (hands, feet and fingers), gangrene can also damage muscles and internal organs (common is gangrene of the appendix). The risk of gangrene increases exponentially in the presence of pathological states which affect the blood and damage blood vessels, such as diabetes and atherosclerosis in particular.
The patient's prognosis is good only when gangrene is diagnosed early and treated early with heavy antibiotics and / or surgery: in all other cases, the patient faces death.

Causes and types of gangrene

DRY CANCER: gradual but inexorable, dry gangrene is induced by an "ischemia, ie a reduction / blockage of blood flow in the arteries in certain areas of the body (particularly in the extremities of the limbs). In most cases, patients suffering from this form of gangrene do not have infections (because bacteria have difficulty surviving and proliferate only minimally). The cause is rather sought in metabolic diseases or predisposing conditions such as in particular:

Atherosclerosis and diabetes (mainly), see diabetic foot, more common in the elderly
Thrombosis of arterial vessels
Hypercholesterolemia
smoking
Genetic predisposition: this factor can also play a leading role in the onset of diseases that predispose to gangrene.

In the dry variant, the affected tissue undergoes a "clear chromatic variation: this in fact can take on a pale, bluish, purple, red or even black color (the color variation depends on the type of pathology that induced the gangrene). Dry gangrene it spreads slowly until it reaches an area where the blood supply is able to keep the tissues vital; in this area it stops.

Curiosity
The color change caused by gangrene is mainly due to the release of hemoglobin from hemolyzed red blood cells, induced in turn by the production of hydrogen sulphide by bacteria. In this way, iron sulphide is formed which, stagnating in the tissues, gives the typical black or red color.

The affected area also becomes cold, dry, shrunken and numb, much like a limb of a mummy.

Dry gangrene is the death of a tissue without infectious overlap. It is characterized by dehydration and mummification of necrotized tissues.

When not surgically removed, the affected limb tends to detach spontaneously. For this reason, dry gangrene is generally not considered an emergency; however, the risk of infection of necrotic tissues with consequent transformation into wet gangrene should be remembered. Also, if dry gangrene is diagnosed in time, the limb can sometimes be saved by vascular surgery. In severe cases, the limb is amputated.

WET OR WET CANCER: A typical complication of an infected and inadequately treated wound, wet gangrene affects areas such as the buccal mucosa, lungs, intestines, cervix and vulva. Also in this case, as inherent in the very concept of gangrene, there is an arrest of the blood flow in the affected area; however, unlike the previous case, ischemia does not depend on occlusive processes but on vascular damage caused by trauma and bacterial infections.

Curiosity
Even pressure sores, while dry, can be considered a form of wet gangrene.
Tissue affected by wet gangrene is targeted by bacteria (eg. Clostridium perfringens or Bacillus fusiformis); as a result, it begins to swell, while giving off a very unpleasant rot smell due to the stagnant blood. The wet gangrene tends to spread rather quickly due to the venous and arterial blood block: the bacteria that stagnate in this area proliferate very quickly, up to septicemia (blood infection).
The tissue affected by soft gangrene is rotten, edematous and dark in color. Unlike dry gangrene, wet gangrene is a real urgency that must be treated immediately with surgery (cleaning the infected tissue in the operating room) and with antibiotics in the vein (generally multiple). The risk, in fact, is not limited to the loss of the limb but also concerns the danger of losing one's life.

GASEOUS CANCER: it is a "bacterial infection that causes the formation of gas inside the tissues." The main culprit seems to be an "exotoxin produced by clostridia (of which the Clostridium perfringens seems to be the most dangerous). These environmental bacteria penetrate the human body through a wound: once they reach the organism, they begin to proliferate indiscriminately, secreting powerful and lethal toxins. By spreading rapidly, the gases produced by the bacteria infiltrate nearby tissues: in this way, the damage it spreads like wildfire. Gas gangrene can cause tissue necrosis, sepsis (or septicemia), toxemia (the presence in the blood of substances in concentrations that are toxic to the organism) and septic shock. Also in this case it is therefore a real medical emergency.

Other types of gangrene

Among the various forms of gangrene we cannot forget necrotizing fasciitis, a violent and sudden infection that affects the soft tissues. The infection is generally operated by bacteria such as group A β-haemolytic streptococcus, staphylococci (especially Staphylococcus aureus) and anaerobes belonging to the genus Clostridium.
Perineal phlegmon (also called Fournier's Gangrene) is also a terrible form of gangrene that affects the male genitalia, caused by Streptococcus pyogenes and other germs such as Klebsiella, E. coli and clostridia.
We cannot forget Noma (gangrenous stomatitis), a type of gangrene that deteriorates and destroys the face, especially the cheeks and mouth. This form of gangrene, which mainly affects immunosuppressed or malnourished children, is responsible for exaggerated damage to the face: affected children are disfigured by the disease, to the point of even showing bones and teeth.