Gangrene R02.x0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Brand; Gangraena; Skin gangrene

Definition
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Dehydration or bacterial decomposition of necrotic tissue.

Etiopathogenesis
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Occurrence at acra of the extremities in case of arterial embolism or microangiopathy (e.g. diabetes mellitus).

Clinical features
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Dry gangrene: mummification, drying and shrinking of the necrotic tissue, resulting in a leathery, black appearance; wet gangrene: decomposition of the necrotic tissue by putrefactive bacteria: transformation into a stinking, putrid, melting mass.

General therapy
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Treatment of the underlying disease, cooperation with angiologists and vascular surgeons. Elimination of risk factors (e.g. nicotine).

External therapy
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  • Dry gangrene: Basically dry treatment to avoid climate for microbial colonization. Antimicrobial treatment by dabbing with polihexanide (Serasept, Prontoderm), polyvidon iodine solution(e.g. Betaisodona solution) or dye solutions, allow to dry and then connect dry. If necessary, protect the environment with hard zinc paste ( R295 ). See also Wound treatment.
  • Moist gangrene: The aim of the treatment is to dry off, remove microbial colonisation and prevent or limit progression. Remove moist necroses, if necessary clean the wound bed with degrading enzymes (e.g. Leukase N ointment). Dab with Polihexanid Lsg. (Lavasept), polyvidon-iodine solution (e.g. Betaisodona, R203 ) or dye solutions; then allow to dry and dress dry. If necessary, blow dry. See also Wound treatment.

Internal therapy
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In case of inflammatory environmental reaction internal antibiotics with broad-spectrum antibiotics such as cefuroxime (e.g. Zinacef) 4 times 1 g/day i.v. Therapy after antibiogram as soon as possible.

Operative therapie
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Keep deep fistulas open, address any osteomyelitis present surgically. The final measure is amputation.

Prophylaxis
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No constricting shoes, soft positioning, relief and immobilization of the affected extremities, careful foot care!

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020