Veeu gangrene ppt 5 th term

gangrene

1. GANGRENE

2. GANGRENE Macroscopic death of tissue with super added putrefaction . Types: dry and wet

3. DRY GANGRENE Blood supply: arterial – gradually deprived venous flow – unimpeded Colour change: Greenish- black – dry- mummfied. Line of demarcation is present .

4. Line of demarcation : D ead tissue and living tissue. Band of Hyperemia layer of granulation Hyperesthesia seen in: Senile, diabetic, buerger’s , raynaud’s , frost bite, vascular occlusion, embolism, ligation

5. WET GANGRENE Arterial & venous block Infection and putrefaction. Cold , pulseless, swollen, oedematous, blebs Horrible odour No line of demarcation Constitutional symptoms present. Spreads faster Seen in : acute inflammation, venous thrombosis, Gas gangrene, bed sores

6. DRY GANGRENE WET GANGRENE

7. C A U SES ARTERIAL OCCLUSION: atherosclerosis, embolism, raynaud’s , buerger’s , cervical rib, syphilitic VENOUS OBSTRUCTION: DVT NERVOUS DISEASE: peripheral neuritis, tabes dorsalis, syringomyelia, leprosy, hemiplegia TRAUMATIC : Direct or indirect INFECTIVE: carbuncle, cancrum oris, gas gangrene, fourniers gangrene

8. R a yna ud s d i s e a s e : you n g w o m e n , p ulse unaffected. Embolic Gangrene : sudden, pain, cold and numb limb, pulse less

9. Fournier ’s gangrene : vascular ,infective gangrene of scrotum Obliterative arteritis of scrotum – cutaneous gangr ene Gangrene of internal organs: bowel, gall bladder, appendix etc. Wet type of gangrene Incarcerated hernia or volvulus sepsis

10. GAS GANGRENE Clostridium Trauma and ischaemia Exotoxins produced Necrosis with gas production – rapidly CF: pain , fever, swelling, Toxaemia, foul sm khaki brown skin, Crepitus Types : fulminant , massive, group , subcutaneous, single

11. TREATMENT: INJ benzyl pencillin 20 lac IU 4hrly + metrinidazole Fresh blood transfusion Polyvalent antiserum 25000 units iv every 6hrs Hyperbaric oxygen Excision and debridement Rehydration and electrolyte management amputation8

12. PHYSICAL GANGRENE Frost bite : exposure to cold Damage to arteries-edema- blisters – gangrene Painless, waxy. Dry gangrene

13. BURNS GANGRENE: ELECTRICAL GANGRENE: CORROSIVE GANGRENE:

14. Drugs causing gangrene: Inadvertent injection of drugs Iatrogenic- intraarterial injection of thiopentane Ergot preparations

15. INVESTIGATION 1. Blood: routine examination WR – Syphilis sugar- diabetes, TG, cholesterol. urea, electrolytes Urine: sugar , renovascular insufficiency X ray: atherosclerosis , aneursym, gas – gas gangrene, bone erosion in gangrene ECG- Cardiac status USG – ABDOMEN Pus - culture

16. X RAY GAS GANGRENE ATHEROSCLEROSIS

17. 7. Doppler: Duplex 8 scan : b mode usg & doppler Arterial flow , flow rate, velocity, stenosis, block. Ankle brachial pressure index: < 0.3 severe ischemia – gangrene SEGMENTAL PRESSURE: PLETHYSMOGRAPHY: Segmental plethysmography is introduced by placing venous occlusion cuffs around thigh, calf, ankle Cuffs inflated to 65mmhg and pulsation is quantitative measure of arterial diseases.

18. 10. Arteriography: Contrast – Hyphaque 45( sodium diatriozoate ) aortoiliac / femoropopliteal arteriography. Retrograde percutaneous catherterization: Seldinger’s technique X rays taken TAO – CORK SCREW May ppt gangrene

19. S E L DINGERS TECHNIQUE

20. CT/ MRI Angiogram: OSCILLOMETRY : we can assess level amputation Gas gangrene: culture, x ray, LFT, CT, Sr urea, creatinine

21. 8 ELECTRO MAGNETIC FLOW METER

22. ISOTOPE TECNIQUE Xenon133 IM Technetium 99 Recent IV injection of isotope has been used to get direct arterial visualisation Gamma camera used to picturise blood flow

23. BROWNS VASO MOTOR INDEX: Method : nerve block with local anesthesia or spinal anesthesia is given and any rise in skin temperature is recor ded and compared with rise o f mouth temperature Browns vasomotor index > 3.5 or more operation is advisable

24. TREATMENT L I M B S A V I NG M E T HOD S : DRUGS: Antibiotics Vasodilators Pentoxiphylline, dipyridamole, aspirin, toclpidine.

25. C a r e o f f o o t : Dry Foot wear- MCR Nutrition Avoid injury, pressure, warming Pus drainage Control diabetes Treat cause

26. Surgeries: Lumbar sympathectomy omentoplasty Profundaplasty Endarterioectomy Femoropopliteal thrombectomy Arterial bypass graft

27. SYMPATHECTOMY P R O F U N D OP L AS T Y

28. B Y P A S S E M B OLE C T OMY GRAFT

29. E N D ARTE C T OMY O M EN T O P L AS T Y

30. Life saving pr o ce d u r e : AMPUTATION : Ray amputation Below knee amputation Above knee amputation: Trans condylar – Gritti stokes amputation: Modified syme’s :

31. RAY AMPUTATION

32. ABOVE KNEE AMPUTATI O N

33. GULLITON AMPUTATION

34. Lisfranc’s amputation: Choparts amputation: Transmetatarsal amputation