gangrene

(gang′grēn″)

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(gan′grēn″ )
[Gr. gangraina, a corrosive sore]
Necrosis (death of tissue), usually resulting from deficient or absent blood supply.
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GANGRENE ; SEE: necrosis

ETIOLOGY
Gangrene is usually caused by obstruction of the blood supply to an organ or tissue, as from inflammation, injury, or degenerative changes such as arteriosclerosis. It is commonly a sequela of infections, frostbite, crushing injuries, or diseases such as diabetes mellitus and Raynaud disease. Emboli in large arteries in almost any part of the body can cause gangrene of the area distal to that point. The part that dies is known as a slough (for soft tissue) or a sequestrum (for bone). The dead matter must be removed before healing can take place.

PATIENT CARE
The older or diabetic patient is assessed for arterial insufficiency related to decreases in the strength and elasticity of blood vessels. Capillary refill is also assessed. The presence and strength of distal pulses and the patient's normal response to light and deep palpation are checked. Symmetry, color, temperature, and quantitative and qualitative changes in fingernails or toenails, skin texture, and hair patterns are assessed. Any unusual areas of pigmentation indicating new skin lesions or scarring from past injury or ulceration are observed and documented, with descriptions of the extent and nature of gangrene that is present.

If prescribed, vasodilating and thrombolytic agents are administered, and the patient's response is evaluated. If surgical intervention is required, the patient's understanding of the procedure, its desired effects, and possible complications are evaluated. Health care professionals collaborate with the surgeon to instruct and prepare the patient for surgery and the postoperative period. Postoperative care will depend on the procedure. If amputation is required, the patient must understand that the level of amputation depends on determining the presence of viable tissues to ensure healing and the requirements for fitting a prosthesis. The entire health care team must understand the patient's perception of the amputation in order to assist with resolution of grief and adjustment to a permanent change in body image. Physical and occupational therapists help the patient deal with changes in mobility and ability to perform activities of daily living. The multidisciplinary rehabilitation team involves the patient, nurse, physician, social worker, psychologist, prosthetist, and physical and occupational therapists. The patient's age and presence of other body system dysfunctions affect immediate and long-term responses to treatment. The at-risk patient should be taught preventive measures such as avoiding exposure to cold; keeping the extremities covered with gloves, clean, dry socks, and well-insulated footwear; and promptly treating any breaks in skin integrity.

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