Dry gangrene is an unusual condition in the form of dryness in some parts of the skin that gradually turn black due to lack of blood flow. In severe cases, the skin and tissue may be detached. Dry gangrene is different from other types of gangrene because it is not accompanied by infection due to burning or other trauma that causes the blood supply to cut off to the body's tissues, as well as the discharge of pus or other fluids. Dry gangrene usually affects the extremities, especially the legs and arms, although it can also affect the muscles and internal organs. People with certain diseases, such as diabetes, peripheral artery disease, or autoimmune diseases, are at increased risk of dry gangrene.
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Part 1 of 3: Changing Your Lifestyle
Step 1. Quit smoking
Quitting smoking can help prevent gangrene and its severity because smoking also stops blood flow to the blood vessels. When the blood stops flowing, the tissue dies, and that's when gangrene forms. Anything that stops circulation should be avoided, including smoking.
- Nicotine, which is the active ingredient in cigarettes, has a strong effect on blood vessels. Nicotine constricts blood vessels so that blood flow is blocked. Parts of the body that lack blood flow are also deprived of oxygen. Lack of oxygen for a long time will make body tissues turn into necrotic tissue (dead tissue) which causes the formation of gangrene.
- Smoking is also associated with a number of vascular diseases that can cause narrowing and hardening of the arteries.
- Gradual smoking cessation is recommended because drastic measures will cause withdrawal symptoms which in turn shake the commitment to quit smoking.
- Ask your doctor for help in developing a smoking cessation program.
Step 2. Change your diet
Gangrene causes damage to tissues and muscles due to inadequate blood circulation. Therefore, you should eat foods high in protein and calories to help repair muscles and tissues. Protein can also help rebuild damaged muscle, while nutrient-rich foods (not junk food or zero calories) provide the body with energy to undergo the processes it needs to function.
Foods high in protein but low in fat that prevent artery clogging include turkey, fish, cheese, lean beef and pork, tofu, beans, and eggs. Avoid fatty foods such as red meat, butter, lard, hard cheeses, tarts and crackers, and fried foods. Instead, try to eat green leafy vegetables as a daily consumption
Step 3. Include foods high in germanium and other antioxidants in your menu
Germanium is an antioxidant and is believed to increase the function of oxygen in the body, although most of the current evidence is doubtful by many. Germanium also boosts the immune system and has anticancer properties.
- Foods high in germanium include garlic, onions, shiitake mushrooms, wheat flour, bran, ginseng, green leafy vegetables, and aloe vera.
- Due to the lack of strong scientific evidence about germanium as a supporter of oxygen circulation to the tissues of dry gangrene sites, there is no recommended dose or amount of consumption. Ask your doctor if taking more germanium will help in your case.
Step 4. Watch your sugar intake
While monitoring sugar intake is important for everyone, it is even more important for people with diabetes. Diabetic patients should reduce sugar consumption so that blood sugar levels are as recommended based on hours, meal schedules, and exercise routines. They should also regularly check for signs of sores, redness, or infection in the arms and legs.
People with diabetic neuropathy should check themselves daily for numbness in the arms, legs, fingers, and toes as it is a sign of ineffective blood circulation. High sugar intake is correlated with high blood pressure which greatly affects the normal flow of blood in the blood vessels
Step 5. Limit alcohol intake
Alcohol consumption beyond the daily recommended limit can cause a spike in blood pressure and an increase in cholesterol in the blood which in turn causes blood flow resistance.
Women should limit alcohol consumption to one drink per day and men to two drinks per day. Note that one drink is approximately one bottle/can of beer (350 ml), one glass of wine (150 ml), or a mix containing 45 ml of liquor
Step 6. Start exercising
Although the effects of exercise in the development and treatment of dry gangrene are not clearly known, exercise can reduce the health problems that cause dry gangrene. For example, one study found that a program of 30 to 40 minutes of walking on a treadmill three to four times a week alleviated symptoms of claudication, or painful cramps in the legs because the muscles don't get enough blood flow.
Consider doing moderate exercise at home, either walking on a treadmill or in a home environment as directed above. Record your exercise activities in a journal as well as any symptoms or feelings you experience. Consult your doctor before starting an exercise program if you have heart problems or other health conditions
Step 7. Perform limited limb-specific exercises
If you can't move freely, do passive movement exercises. This exercise requires the assistance of another person so that you can move your joints in full motion regularly to avoid muscle contractures (permanent shortening of joints and muscles) and improve blood flow to certain body parts. The exercises in question are:
- Head exercises, such as turning and tilting your head and moving your chin to your chest.
- Shoulder and elbow exercises such as bending the elbows, moving the elbows up and down and from side to side.
- Upper arm and wrist exercises, such as bending and twisting the wrist, and moving up and down.
- Hand and finger exercises, such as bending the fingers, spreading the fingers, and rotating the fingers.
- Hip and knee exercises, such as bending the hips and knees, moving the leg from side to side, and twisting the leg.
- Foot and ankle exercises, such as bending and twisting the ankle, moving the foot from side to side, bending the toes, and spreading the toes.
Step 8. Treat the wound
Pain or burning should be treated immediately, especially if it occurs in people with diabetes, as it can cause irreversible wounds. Regardless of whether you have gangrene or are concerned about the risks, you must keep the wound clean and protect it while the body tries to build a capillary bed under the scab or scab. Follow these steps:
- Clean the wound with Betadine or peroxide, then apply a prescription antibiotic cream.
- After thorough cleaning, cover the wound with a sterile bandage and clean cotton socks. Cotton can absorb moisture from the wound and increase air circulation which can aid healing.
Step 9. Apply chili, garlic, honey, or onion on the wound area
Chili solution, which is a liquid extract made from chili peppers, helps relieve pain, improves the functioning of the circulatory system, and reduces the risk of developing an infection. You can buy chili solution from a drug store. Apply to the wound area two to three times a day or as directed by a doctor.
- You can also crush a few cloves of garlic and apply it directly to the wound. This was standard treatment during World Wars I and II because garlic has antimicrobial properties to prevent or treat gangrene infections and antiplatelet properties that help break up the blood clots that cause gangrene.
- Alternatively, use a bandage that has been given a slice of garlic on the wound area. You can slice a clove of garlic and wrap it around the wound area with a clean cloth. Leave it for five to ten minutes and do it several times a day. This will increase circulation in the wound area.
- Try applying honey to the wound. Honey has long been used to treat burns, cuts or tears, and suppuration. Research is still ongoing, but honey has been shown to have antibacterial properties. Make sure you use sterile, laboratory-tested honey. Apply honey on a bandage or bandage, then wrap it around the wound. You can also buy pads that have been smeared with honey.
Part 2 of 3: Seeking Medical Treatment
Step 1. Undergo surgery to remove dead tissue
The surgical procedure is performed if the gangrene has progressed very badly and the dead tissue has to be removed. How much dead tissue to remove usually depends on how far the blood has reached the gangrene area and its location. Surgery is the standard treatment for dry gangrene. Surgical procedures that may help include:
- Skin debridement. This surgical procedure is performed by removing the tissue that is rotted by gangrene. Sometimes the skin is replaced with another healthy skin tissue (called a skin graft).
- Amputation. If any tissue is completely dead and other medical and surgical procedures cannot save the area, the hands and feet or other body parts may have to be amputated to prevent the spread of gangrene to nearby areas and other parts of the body. This surgical intervention is performed when skin debridement is no longer helpful. Be aware that in most cases, with the exception of life-threatening cases, the decision to amputate will only be made after full consultation with the doctor so that the patient can make an informed choice based on all the information provided.
Step 2. Consider maggot therapy
As an alternative to surgery, maggot therapy is also an option that can remove dead tissue. In this non-surgical procedure, maggots from fly larvae are placed over the gangrenous area and then covered with a gauze bandage. Maggots feed on dead tissue and fortunately, ignore healthy tissue. Maggots are also useful for fighting infections because these tiny animals release substances that kill bacteria.
There is some research showing that treatment with maggots may be more effective than surgical debridement. However, most people are afraid or hesitant to try these alternatives because maggots are considered disgusting
Step 3. Undergo hyperbaric oxygen therapy
This is an alternative treatment. You are placed in a special chamber filled with compressed air. Then, a plastic hood is attached to your head so you can breathe pure oxygen. As scary as it sounds, it is an effective therapy that delivers high levels of oxygen to the blood, provides oxygen to the gangrenous area, and improves blood flow and supply. Blood will reach gangrenous areas, even in patients with inadequate blood supply.
- If there is enough oxygen delivered to the gangrenous area, the risk of amputation can be reduced. Studies have confirmed that hyperbaric oxygen therapy is effective in treating foot gangrene associated with diabetes and reducing the risk of amputation.
- Make sure you discuss whether hyperbaric oxygen therapy is right for you.
Step 4. Restore blood flow through surgery
The main surgeries to restore blood flow are bypass surgery and angioplasty. Studies show that both surgeries are equally effective at restoring blood flow and reducing the need for amputations. However, angioplasty has a shorter recovery time, although bypass appears to be more effective in the long term. Talk to your doctor about the best course of action for your condition and medical history.
- Bypass operation. In this operation, the surgeon changes the direction of blood flow by "surrounding" the blocked area. The surgeon will connect one of the veins with part of one of the healthy arteries with a graft technique.
- Angioplasty. Angioplasty uses a small balloon that is placed into a blocked or very narrow artery. Then, a small balloon is filled with air to expand and open the blood vessels. In some cases, the surgeon will also insert a metal tube, called a stent, into the artery to keep it open.
Step 5. Take medication to reduce blood clots
Your doctor may prescribe an anticoagulant to reduce blood clots so they can improve their flow. One of the anticoagulants is warfarin which is usually taken (2 to 5 mg) once a day (at the same time every day) in tablet form. Warfarin inhibits and interferes with the work of vitamin K so that it can slow blood clotting. The result is more diluted blood so that circulation is more efficient.
Please note that anticoagulants will make you bleed more easily and may not be able to take this medicine if you have a history of bleeding (such as hemophilia), cancer, kidney or liver disease, heart disease, or high blood pressure. Always consult a doctor before taking any medication that affects the blood's ability to flow and clot normally
Step 6. Treat any possible infections
Antibiotics are usually given to patients who have gangrene due to infection or who are concerned about the development of infection because the wound is open or not healing properly. Doctors will usually prescribe antibiotics to gangrene patients after surgical removal of tissue to prevent infection of other body tissues. Medications that are usually prescribed include:
- Penicillin G. This is an antibiotic that has long been the treatment of choice for gangrene. Typically, Penicillin G 10–24 million units per dose (every six to eight hours) is given by intravenous (venous access) or intramuscular (muscular access) injection. This antibiotic has a bacteriostatic effect that inhibits or prevents the reproduction and growth of bacteria. Compared to the oral form, injection is generally preferred for severe infections or patients undergoing surgery because it can be given in larger doses and reach the gangrenous area more quickly. Now, penicillin and clindamycin, which are protein blockers, are generally prescribed together.
- Clindamycin. This drug treats and prevents infection with a bactericidal effect that kills bacteria by blocking the protein production process in bacteria. Without this protein, bacteria cannot survive. The usual dose is 300–600 mg orally every six to eight hours or 1.2 grams intravenously twice daily.
Step 7. Begin supportive care
Surgical wound care is usually provided from the postoperative patient care program. This treatment is a rehabilitation therapy to restore the normal function of the fingers, toes, arms, or legs affected by gangrene. One part of rehabilitation therapy is doing isotonic exercises to maintain the function of the area affected by gangrene. Exercise can move the joints and muscles in the arms and legs. These isotonic exercises include:
- Brisk walk or leisurely walk
- Bicycle
- Dance
- Jump rope
Part 3 of 3: Understanding Gangrene Penyakit
Step 1. Find out what causes dry gangrene
Dry gangrene may be the result of the following factors:
- Diabetes. This condition blocks blood flow, particularly in the lower extremities and can cause irreversible sores.
- Vascular problems. Vascular problems, such as peripheral artery disease, can reduce the blood supply in the body. For example, this disease occurs when the arteries of the heart or body are narrowed due to atherosclerosis, which hardens the arteries and blood vessels.
- Vasculitis. This refers to some autoimmune conditions that cause blood vessels to become inflamed, such as Raynaud's phenomenon. In this autoimmune disease, the blood vessels, especially in the fingers and toes, temporarily spasm (called vasospasm) which in turn causes vasoconstriction, or narrowing of the blood vessels. Triggers for Raynaud's phenomenon include exposure to cold and emotional stress.
- Tobacco addiction. Tobacco can cause blockage of the arteries thereby interfering with blood flow.
- External injury. Burns, accidents, injuries, and surgery can damage certain cells in the body which in turn slows down the blood supply. If the wound is not treated properly and major blood vessels are damaged or injured, these vessels can no longer supply enough blood to the surrounding tissues. This causes a lack of oxygen supply to the injured body part and as a result, the surrounding tissue will die.
- Frostbite. Exposure of the extremities to temperatures that are too cold can block blood flow. In freezing temperatures, frostbite can occur in as little as 15 minutes. In principle, frostbite affects the fingers and toes. As a precaution, you can wear layered gloves and shoes to provide warmth and protection from moisture.
- infection. Untreated bacterial infections can invade the infected tissue so that it dies and causes gangrene. This is more common in wet gangrene.
Step 2. Understand the different types of gangrene
Gangrene can be classified into several categories, including:
- Dry gangrene. This type of gangrene is characterized by dry, wrinkled skin that is brown to purplish-blue or black in color. Dry gangrene usually grows slowly and eventually the tissue will detach. Dry gangrene can become wet gangrene if infected.
- Wet gangrene. The main signs of wet gangrene include swelling, blistering, and a wet appearance in the tissue affected by gangrene due to the discharge of fluid. Wet gangrene develops after infection in the tissue. This type of gangrene requires urgent treatment because it can progress quickly and is very dangerous.
- Gas gangrene. This type of gangrene is a subtype of wet gangrene. In this condition, the surface of the skin generally appears normal, but as it progresses, gangrene becomes pale and then gray to purplish-red. The foamy appearance of the skin also becomes clearly visible and audible when the area is pressed. This is due to infection by a gas-producing organism, Clostridium perfringens, which causes tissue death via gas.
- Gangrene noma. This condition is a very fast-growing form of gangrene that often affects the mouth and face. This type of gangrene is most common in malnourished children living in conditions with inadequate hygiene.
- Internal gangrene. This type of gangrene occurs when blood flows into internal organs such as the intestines, gallbladder or appendix. Gangrene usually causes fever and sharp pain. If not treated, this condition can be life threatening.
- Fournier's gangrene. This condition is very unusual because it involves the genital organs and urinary tract. This condition is more common in men than women.
- Meleney's gangrene or progressive bacterial synergistic gangrene. This is a rare type of gangrene that occurs after surgery and is accompanied by painful sores that develop a week or two after surgery. The pain is sharp and itchy.
Step 3. Know the symptoms of dry gangrene
Dry gangrene is a serious condition that requires prompt and effective treatment. Any individual experiencing any of the following symptoms should see a doctor immediately to avoid further complications:
- Numbness and coldness in the affected area and the skin around it looks wrinkled.
- Claudication, or cramping (eg in the legs when walking)
- Pain such as tingling, stinging, or itching
- Discoloration in the affected area (may turn red, pale, purple, and black if not treated).
- Dry in the sore area
- Painful
- Septic shock (low blood pressure, fever, confusion, dizziness, shortness of breath). Septic shock is considered a medical emergency and requires immediate medical attention. These symptoms are rare in dry gangrene, but are possible if not treated properly.
Step 4. Seek immediate medical attention
Gangrene is not a self-limiting condition. If you don't seek immediate treatment, you may run the risk of amputating the part of your body affected by gangrene. Visit a doctor immediately to begin to relieve the problem of dry gangrene.
- Keep in mind that some people don't experience the pain that accompanies dry gangrene so don't consult a doctor until the hands and feet turn black. Be alert and call your doctor as soon as you notice the above symptoms. Don't wait for the situation to get worse.
- Home remedies do work, but they are not effective enough to treat dry gangrene. Begin medical treatment, the sooner the better, so that gangrene symptoms disappear much faster.
Warning
- You should consult a doctor as soon as you experience symptoms of gangrene to get an early diagnosis and prompt treatment.
- For those of you who are at risk of developing dry gangrene, especially if you have diabetes or peripheral vascular disease, you should understand dry gangrene and pay close attention to its symptoms. Have regular check-ups with your doctor to determine the risks and symptoms you may experience.
