Gangrene

This is a dreaded consequence of inadequately treated missile wounds, crushing injuries and high-voltage electrical injuries.

Non-clostridia gas-producing organisms such as coliforms have also been isolated in 60–85% of cases of gas gangrene. [1]

Indian epidemiology then other

Causes

• The common causative organism is Clostridium perfringens, a spore-forming, Gram-positive saprophyte that flourishes in anaerobic conditions.
• Other organisms implicated in gas gangrene include bifermentans, C. septicum and C. sporogenes.
• They are present in the soil and have also been isolated from the human gastrointestinal tract and female genital tract.
• Clostridium perfringens produces many exotoxins but their exact role is unclear.
• Clostridium perfringens produces many exotoxins but their exact role is unclear.
• Alpha-toxin, the most important, is a lecithinase, which destroys red and white blood cells, platelets, fibroblasts and muscle cells.
• The phi-toxin produces myocardial suppression whereas the kappa-toxin is responsible for the destruction of connective tissue and blood vessels.

Contamination of wound

• Wounds become contaminated with clostridial spores and the devitalized tissue, foreign bodies and premature wound closure provide the anaerobic conditions necessary for spore germination.
• The usual incubation period is < 24 hours but it can range from 1 hour to 6 weeks. A vicious cycle of tissue destruction is initiated by rapidly multiplying bacteria and locally and systemically acting exotoxins.
• Locally, this results in spreading necrosis of muscle and thrombosis of blood vessels while progressive oedema further compromises the blood supply. The typical feature of this condition is the production of gas that spreads along the muscle planes.
• Systemically, the exotoxins cause severe hemolysis and, combined with the local effects, this leads to rapid progression of the disease, hypotension, shock, renal failure and acute respiratory distress syndrome (ARDS). [1]

• Examples of causes include:
  
  • Pathogens: Viruses, bacteria, fungi, parasites (infectious diseases)
  • Genetic mutations: Inherited or spontaneous changes in genes (genetic diseases)
  • Environmental factors: Toxins, radiation, nutritional deficiencies
  • Lifestyle choices: Smoking, unhealthy diet, lack of exercise (contributing factors)

Gas gangrene:

• Gas gangrene typically affects deep muscle tissue. If you have gas gangrene, the surface of your skin may look normal at first.
• As the condition worsens, your skin may become pale and then turn gray or purplish red.
• The skin may look bubbly and may make a crackling sound when you press on it because of the gas within the tissue.
• Gas gangrene is most commonly caused by infection with a bacterium called Clostridium perfringens.
• Bacteria gather in an injury or surgical wound that has no blood supply.
• The bacterial infection produces toxins that release gas and cause tissue death. Like wet gangrene, gas gangrene is a life-threatening condition.

Dry gangrene

Wet gangrene

Internal gangrene

Fournier’s gangrene

Meleney’s gangrene [2]

Risk factors are things that make you more likely to develop a disease in the first place.

Pathogenesis refers to the development of a disease. It’s the story of how a disease gets started and progresses.

This is the entire journey of a disease, encompassing the cause but going beyond it.

Pathophysiology, on the other hand, focuses on the functional changes that occur in the body due to the disease. It explains how the disease disrupts normal physiological processes and how this disruption leads to the signs and symptoms we see.

Imagine a car accident. Pathogenesis would be like understanding how the accident happened – what caused it, the sequence of events (e.g., one car ran a red light, then hit another car). Pathophysiology would be like understanding the damage caused by the accident – the bent fenders, deployed airbags, and any injuries to the passengers.

In simpler terms, pathogenesis is about the "why" of a disease, while pathophysiology is about the "how" of the disease’s effects.

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• The earliest symptom is acute onset of pain that increases in severity as the myo-necrosis progresses.
• The limb swells up.
• The wound exudes a serosanguinous discharge.
• The skin is involved secondary to underlying muscle necrosis, turning brown and progressing to a blue-black colour with the appearance of hemorrhagic bullae.
• The characteristic sickly-sweet odour and soft tissue crepitus caused by gas production appear with established infection but the absence of either does not exclude the diagnosis.
• These local signs are accompanied by pyrexia, tachycardia disproportionate to body temperature, tachypnoea and alteration in mental status. [1]

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• The diagnosis make on the basis of history and clinical features: a peripheral blood smear may suggest hemolysis; additionally a Gram stain of the exudate reveals large Gram-positive bacilli without neutrophils; and the biochemical profile may show metabolic acidosis and renal failure.
• Radiography can visualize gas in the soft tissues and computerized tomography (in other words, CT) scans are useful in patients with chest and abdominal involvement. [1]

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

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• High-dose penicillin G also clindamycin.
• Third-generation cephalosporins intravenously.
• The mainstay of management is early surgical excision of the necrotic tissue.
• The muscle planes open through generous longitudinal incisions and all devitalized tissue remove, going beyond the area of induration.
• Abdominal involvement may necessitate excision of the wall musculature.
• Excision should continue daily until the process of necrosis has stopped spreading.
• In established gas gangrene with systemic toxicity, amputation of the involved extremity is life saving and should not delay.
• The role of HBO is not as clear as in necrotizing fasciitis but it recommend in severe cases if the facilities are available. [1]

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Homoeopathic Treatment:

Homeopathic Treatment 

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

•  The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

 A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

 What Homoeopathic doctors do?

 A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

 Homeopathic Medicines 

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

1.Aconite:

• Deathly paleness of face also shuddering.
• The part first swells and then assumes a blackish color.
• Sleeplessness also restlessness.
• Chilliness from least uncovering; additionally, sweat cool in palms of hands; coldness of feet up to malleoli, with sweat on toes and soles of feet.

2.Arnica:

• In general, Hard, hot and shining swelling of parts affected; gangrene follows contused wounds.
• Thirst before fever; pain in periosteum of all the bones.
• Besides this, Pain in cartilage of ears, as if contused; swelling of nose, with feeling as if from ulceration of nostrils; tendency to boils also  carbuncles

3.Arsenic Alb: 

• Senile gangrene; ulcers extremely painful or entirely insensible, with elevated edges.
• Secreting a bad, watery foetid ichors; hard, shining, burning swelling with bluish- black, burning vesicles, filled with acrid ichor.
• Aggravation especially from warmth, from cold; extreme restlessness.
• Moreover, Gangrene accompanied by foetid diarrhoea.
• Great weakness and emaciation; numbness, stiffness and insensibility of the feet.
• Lastly, General coldness with parchment-like dryness of the skin, followed by heat.

4.Asafoetida:

• Dark-red and hot swellings; bright-red appearance of the wounds.
• Which are sensitive to touch; coldness also dryness of skin with rapid pulse.

5.Aurum:

• Gangrenous diseases with edematous swelling of the parts; very sensitive to cold.
• Aggravate especially at night, disturbing sleep; low- spirited, with suicidal ideas.

6.Belladonna:

• Generally, Fiery redness of swelling, even Erysipelatous.
• Dry, hot skin, thirst also headache, Erysipelatous indurated swellings which mortify.
• Accompanied by glandular swellings; Besides this, secretions of bloody ichor.

7.Bromium:

• Hospital gangrene, death of the edges of the wound; cancerous ulcer in face.
• In detail, stony-hard swelling of glands, especially on lower jaw and throat.
• decayed teeth also gums; foul breath; much prostration and emaciation.
• Lastly, psoric constitution

8.Carbo veg:

• Senile gangrene
• Humid gangrene in cachectic persons whose vital powers are exhausted.
• great foulness of the secretions; great prostration; sepsis; indifference; fainting after sleep, while yet in bed, morning; no restlessness.

9.China:

• In general, After profuse and frequently repeated hemorrhage.
• With coldness of the extremities or of the whole body, with pale also clammy face.
• Moreover, The parts around the wound become soft, blue and swollen.
• Bedsores in people who are much debilitated from excessive discharges.

10.Ephorbium:

• Gangrene following either gastritis or enteritis, temperature continually falling;
• inflammation also swelling, followed by cold gangrene; torpor; insensibility of parts affected;
• Lastly, chilliness and shuddering over whole body; gangrene senilis. [3]

• Eating an unhealthy diet high in fat will make any existing atherosclerosis worse and increase your risk of developing gangrene.
• Continuing to eat high-fat foods will cause more fatty plaques to build-up in your arteries. Additionally, This is because fatty foods contain cholesterol.
• There are 2 types of fat – saturated and unsaturated. Avoid foods that contain saturated fats because they increase levels of "bad cholesterol" in your blood.

Foods high in saturated fat include:

• Meat pies
• Sausages and fatty cuts of meat
• Butter & Ghee
• Cream
• Hard cheese
• Cakes and biscuits
• Food containing coconut or palm oil. [2]

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[1] Bailey_and_Love_s_Short_Practice_of_Surgery

[2]https://www.nhs.uk/conditions/gangrene/prevention/]

[3] Homoeopathic Therpeutics by Lilienthal.

Frequently Asked Questions

What is Gangrene?

It is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and subsequent soft-tissue destruction.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Gangrene?

• Aconite
• Arnica
• Arsenic Alb
• Belladonna
• Bromium
• Carbo veg
• China
• Ephorbium

What causes Gangrene?

• Clostridium perfringens
• Bifermentans
• C. septicum
• C. sporogeneses.

What are the symptoms of Gangrene?

• Pain
• Limb swells up
• Serosanguinous discharge.
• Muscle necrosis
• Sickly-sweet odour
• Pyrexia
• Tachycardia
• Tachypnoea

Give the types of Gangrene?

• Dry gangrene
• Wet gangrene
• Internal gangrene
• Fournier’s gangrene
• Meleney’s gangrene