Gangrene Gangrene is necrosis (death) of body tissue due to lack of blood flow or bacterial infection. Gangrene most often affects the extremities, including fingers, st.

03.02.2021

The onset of old age is often accompanied by a deterioration in health; older people suffer from chronic diseases and their exacerbations. One of the most severe conditions that are diagnosed in old people is gangrene of the lower extremities. The disease is characterized by its insidiousness and rapid increase in symptoms, leads to disability of the sick person and can cause death.

Few people know that, in accordance with the current legislation of the Russian Federation, elderly parents have the official right to receive financial assistance from their children. Alimony can be received by pensioners, persons with disabilities who have lost the ability to independently provide for their existence. If the future heir refuses to voluntarily fulfill the obligations assigned to him, the elderly parents can go to court.

What is gangrene

Gangrene is a necrotic change in tissue (death), the condition develops as a result of impaired blood flow, its complete cessation in the damaged area, and the development of a bacterial infection. Most often, the disease is localized in the lower extremities, affecting the toes, feet, or the entire leg area. In some, especially severe cases, internal organs and muscle tissue are affected.

You can suspect the onset of the disease by a characteristic change in skin color - it begins to turn black, brown and blue spots appear. The skin becomes discolored as a result of the release of iron sulfide as a result of the destruction of hemoglobin. Depending on the symptoms and pattern of the dangerous condition, dry and wet gangrene are distinguished.

TESTS AND DIAGNOSTICS

Tests used to diagnose gangrene include:

• Blood tests.
  An abnormal increase in white blood cells often indicates the presence of an infection.
• Instrumental methods.
  X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may be used to examine internal organs and assess how much gangrene has spread.
• Arteriography
  is a test used to visualize the arteries. During this test, a dye is injected into the blood and a series of X-rays are taken to determine how well the blood is moving through the arteries. An arteriogram can help your doctor find out whether any of your arteries are closed.
• Surgery.
  Surgery may be performed to determine how much gangrene has spread in your body.
• Tissue or fluid cultures.
  A culture of the fluid from a skin blister may indicate Clostridium perfringens bacteria (a common cause of gas gangrene), or the doctor may look at a tissue sample under a microscope for signs of cell death.

Causes of necrosis of the lower extremities in old people

The etiology of the development of necrotic pathologies in people of old age is different. A high risk of getting sick is observed in patients with diabetes mellitus, atherosclerosis and other health disorders associated with circulatory disorders that destabilize the functioning of internal organs. It is customary to distinguish five groups of pathological agents that contribute to the development of necrosis in old age:

• Mechanical disturbance of blood outflow (provokes drying type). Among the causative factors include too tight a cast, which compresses the soft tissue, thereby disrupting normal blood flow. Gangrenous lesions can be a consequence of compressive trauma during road traffic accidents, rubble, or exceeding the permissible time for applying a hemostatic tourniquet.
• Diseases of the vascular system, heart - thrombosis, atherosclerosis and other pathologies.
• Bacterial nature of the disease. A painful condition can be provoked by a non-sterile dressing on a wound, streptococcus, enterobacteria, etc. entering damaged tissues.
• Thermal, chemical burns, frostbite can give rise to an inflammatory process of an infectious nature, which will lead to disruption of blood transport.
• Mechanical injuries, the severity of which is aggravated by infections.

The development of necrosis in elderly people can be provoked by somatic diseases, decreased immunity, lack of vitamins, addiction to alcohol, smoking, sedentary lifestyle (immobilized state as a result of paralysis or amputation), hypothermia of the body, poor health, metabolic disorders caused by old age and related problems . The main danger is the loss of the ability to heal wounds independently as a result of a deficiency of nutrients in the body tissues and their insufficient oxygen supply. Even a minor cut, wound or scratch can cause a non-healing ulcer, which can turn black and develop into a gangrenous one.

RISK FACTORS

Some factors that increase the risk of developing gangrene. These include:

• Age.
  Gangrene is much more common in older people.
• Diabetes.
  If you have diabetes, your body doesn't produce enough of the hormone insulin (which helps cells get sugar from the blood) or your cells are resistant to the effects of insulin. High blood sugar can eventually damage blood vessels, cutting off blood flow to parts of your body.
• Diseases of the blood vessels.
  Narrowing and hardening of an artery (atherosclerosis) and blood clots can also block blood flow to a specific area of ​​the body.
• Severe injuries or surgery.
  Any process that causes damage to the skin and underlying tissue, including injury or frostbite, increases your risk of developing gangrene, especially if you have an underlying medical condition that reduces blood flow to the injured area.
• Obesity.
  Obesity is often accompanied by diabetes and vascular disease, but the pressure of excess weight can also compress arteries, leading to reduced blood flow and increasing the risk of infection and poor wound healing.
• Immunosuppression.
  The body's ability to fight infection is impaired by human immunodeficiency virus (HIV) infection or after chemotherapy or radiation therapy.
• Medicines.
  In rare cases, the anticoagulant drug warfarin may cause gangrene, especially when combined with heparin therapy.

How does gangrene manifest in an elderly person?

The clinical symptoms of the disease depend on the nature, extent of the lesion, the nature of its occurrence, the localization of the lesion and the rate of development of gangrenous disease in an elderly patient. The manifestations of wet and drying gangrene also vary.

Symptoms of the dry type, characteristic of elderly patients with poor health, low body weight, and prone to dehydration:

• acute pain localized in the leg; in the initial stage, no change in skin color is noted;
• the pulse in the affected area is difficult to palpate, the leg becomes pale and cold, and later begins to turn black;
• limited area of ​​the lesion with pronounced demarcation - gangrenous lesions often start from the fingers, spread higher and end in a healthy area with normal blood circulation;
• as the disease develops and symptoms increase, the tissues decrease in volume, gradual drying, wrinkling and mummification of the affected leg is observed;
• sensitivity decreases, movements become difficult;
• fabrics gradually turn black - color from brown to black;
• dry type is usually not accompanied by infection;
• the general condition of the patient is satisfactory, symptoms of intoxication are mild or absent;
• if it is not possible to perform surgical amputation, the affected area is rejected on its own.

Manifestations of the wet type, characteristic of older people prone to obesity:

• at the beginning of the disease, the skin becomes pale in color, the affected area becomes cold as a result of poor blood circulation;
• the pulse in the arteries can barely be felt, the venous network appears, and the leg visually becomes swollen;
• characteristic red gangrenous spots appear on the skin;
• as inflammation increases, healthy tissues are involved in the process; there is no clear boundary between healthy and areas that have already turned black;
• there is a strong fetid odor of decaying flesh, the spots become black;
• unlike the second type, the fabrics do not dry out and remain moist;
• as a result of an increase in painful symptoms, the condition of the sick person worsens, and intoxication of the body is observed;
• the pain is acute, intense, conventional painkillers do not help;
• body temperature is high, blood pressure drops, pulse quickens;
• loss of appetite, the patient refuses water;
• without proper therapy, sepsis and inevitable death of an elderly patient occurs.

There are a number of symptoms, the development of which indicates a predisposition and the initial stage of the disease - cold lower or upper extremities regardless of the time of year, frequent cramps, fatigue when walking, changes in the sensitivity of the legs, poorly healing wounds that may turn black over time, etc. Such signs cannot be ignored; immediate consultation with a specialist is required for consultation and diagnosis of the disease. It is important to remember that gangrene develops rapidly and in a short time can lead to disability and death in an elderly patient.

Forecast

In the absence of surgical care, all patients with wet gangrene die from sepsis. The main approach to treatment is still emergency high amputation. Therefore, we can say that for most patients with wet gangrene, the latter ends in the loss of a leg. To prevent the development of the disease, a diabetic needs to change his lifestyle, lose excess weight, carefully approach the treatment of the foot, and monitor minor finger injuries and abrasions. It is necessary to promptly, at the first signs of changes in the feet and nails, seek help from diabetic foot specialists - podiatrists.

Treatment of gangrene in elderly patients

Therapeutic measures begin with a diagnosis based on examination, biochemistry and blood tests, analysis of biomaterial from the wound, ultrasound, and x-ray examination. Therapy for gangrene involves surgery, during which the affected tissue is excised, therapy using antibiotics and other effective methods. The prognosis is favorable provided immediate medical attention is sought and the correct therapy is chosen for the elderly patient.

Let's look at the steps in detail:

• Surgery. It is important to understand that necrotic tissue cannot be preserved, so its removal is inevitable. Excision of dead areas helps prevent further growth of the gangrenous lesion and makes it possible to start the process of regeneration of healthy tissues. To restore normal blood flow, the vascular surgeon artificially increases blood flow; in severe cases, amputation of the fingers, foot, or entire leg is used. During rehabilitation therapy, skin transplantation is often used; the necessary flap is taken from a healthy area of ​​an elderly patient, and then transferred to the affected area. A bandage or suture is used for fixation; the likelihood of engraftment depends on the blood supply.
• Antibiotic therapy. If necrosis is complicated by an associated infection, therapy must be supplemented with antibiotics, which are delivered intravenously or intramuscularly.
• Oxygen therapy (hyperbaric oxygen therapy). The therapeutic method is used to get rid of gas gangrene; during the procedure, the patient is placed in a special chamber. Under the influence of high pressure (2 times higher than usual), the blood is enriched with oxygen, the growth of pathogenic bacteria is stopped, and wounds heal faster. The duration of the session is about 90 minutes, the course consists of 3-5 days.

Other therapeutic methods include supportive measures aimed at stabilizing the patient’s condition and eliminating symptoms. To combat dehydration, IVs are prescribed, and strong painkillers are prescribed to relieve pain. It is important to begin the treatment process as quickly as possible in order to prevent further spread of the infection and not resort to large-scale surgical interventions.

To establish specific figures, the financial situation of both parties (children and elderly plaintiffs) is assessed, as well as:

• the degree of neediness of the elderly generation (a check is carried out for the presence of extraneous financial charges);
• the level of the cost of living, the amount of pensions and other payments;
• living conditions of the elderly generation;
• marital status of both parties;
• current expenses for treatment, accommodation, covering utilities, obligations on loans, mortgages, etc.;
• maintenance of minor family members, guardianship of incapacitated persons;
• the degree of participation in the educational issue and other key factors.

The size of the amount is influenced by the age of the potential alimony payer, the fact of employment, length of service, and the level of his salary. For example, having a pregnant wife or poor health may ease obligations. In addition to fixed alimony obligations, children may be required to compensate for additional expenses associated with forced repairs of a pensioner’s home, treatment, payment for the services of a nurse for an elderly patient, surgical intervention, etc.

High amputation (above the knee)

Gritty hip amputation

Our clinic uses a method of amputation for gangrene of the lower leg, which is promising for prosthetics, if it is impossible to perform amputation of the lower leg. This amputation preserves the patella (“kneecap”) and creates a supporting, long and strong stump on which a lightweight prosthesis without pelvic attachment is used. The operation is technically more complex than simple hip amputation, but the results of prosthetics are much better and are comparable in rehabilitation to lower leg amputation. Our clinic has very positive experience with such amputations.

Video after hip amputation according to Gritty