Gangrene

Death of tissue through shortage of oxygen. There are two kinds of gangrene. In the dry form the tissue dies because of interruption of the blood supply. There is no infection, and the affected part dries up and wastes away. In the wet form, infection sets in after the tissue has died. The affected area looks damp, and often smells very unpleasant because of the infection. The feet are particularly susceptible to diseases linked with restricted oxygen supply to the tissue, caused by interruption of the blood supply as in the case of diabetes, thrombosis, severe atherosclerosis and Buerger’s disease. The first symptom of interrupted blood supply is pain when walking, subsequently persisting when the patient is at rest. The affected area is cold and pale, no arterial pulse can be detected, the tissue is starved of oxygen and dies. In the early stages of gangrene the skin is blue, later darker and then black. Wounds in areas with poor blood supply heal only with difficulty, and gradually become infected, resulting in gangrene. Diabetes affects the nerves, and patients do not feel wounds, so they are often infected before the patient notices. This occurs most usually in the feet (diabetic foot), but only after a number of years. It is then essential to avoid wounds, by not wearing shoes that are too tight, not walking on bare feet and practising adequate hygiene. The feet should be checked for wounds every day. If infection does occur, the area should be kept as dry as possible. Antibiotics are sometimes prescribed to kill the bacteria. Dead tissue must be removed to avoid spreading the infection. Cutting the nerves of the skin

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