The Shock Factor

Warning do not go into this area unless you are prepared for a shock, these are extreme cases that can happen to an individual. It was debatable whether to include this section, a lot of the male diabetics wanted it left on the web site. Looking at this puts a new dimension on the question ‘To test or not to test?’ Anxiety could make a patient want to test every hour so please take this section with the spirit intended of making diabetics think of the worst scenario, however, these conditions are quite rare. Look after that tool. The big question for me was should we be taking more care of our bums?

• Gas gangrene
• Gangrene in the penis
• Gangrene in fingers
• Gangrene in toes
• Gangrene in the anus (Fournier’s gangrene, anorectal 10:1 ratio of males to females suffering with this condition)

Your treatment plan

Treatment for gangrene involves three main objectives:

• to remove the affected tissue (debridement) 
• to prevent infection (or if infection is already present, to prevent it spreading) 
• to address the conditions that led to gangrene developing

For example, if gangrene is caused by a poor blood supply, surgery may be used to repair damaged blood vessels. This is known as vascular surgery.

Debridement

Debridement is the surgical removal of the dead tissue that results from gangrene. Removing the dead tissue will prevent the gangrene from spreading and allow healthy tissue to heal.

In severe cases, where a whole body part such as a finger, toe, or limb is affected, amputation may be the only viable option.

Maggot therapy

Maggot therapy is a non-surgical method of debridement. Maggots have been used to treat wounds for a long time, and during the First World War they became a popular method of cleaning wounds.

Certain types of maggot (those from fly larvae) are ideal for debridement because they feed on dead and infected tissue, but leave healthy tissue alone. They also help to fight infection by releasing substances that kill bacteria, as well as stimulating the healing process.

Maggots that are used for maggot therapy are specially bred in a laboratory using sterilised eggs. During maggot therapy, the maggots are mixed into a wound dressing, and the area is covered with gauze. After a few days, the dressing is cut away and the maggots, which are often 10 times bigger after eating the dead tissue, are then flushed away.

A number of medical studies have shown that maggot therapy can achieve more effective results than surgical debridement. However, due to the nature of this type of treatment, many patients are reluctant to try it.

Infection

Infections are usually treated with antibiotics, either intravenously (injected directly through your vein) or intramuscularly (injected directly into your muscles). In order to counter the effects of infection, and accelerate the healing process, you will also require intravenous fluids and nutrients and, in some instances, blood transfusions.

Vascular surgery

There are two main ways that surgery can be used to restore blood flow. These are described below.

• Bypass surgery, where the surgeon redirects the flow of blood and by-passes the blockage by connecting (grafting) one of your veins to a healthy part of an artery
• Angioplasty, where a tiny balloon is placed into a narrow, or blocked, artery, and is inflated to open up the vessel. A small metal tube (a stent) may also be inserted into the artery to help keep it open

Research suggests that both of these techniques are equally effective in restoring blood flow and preventing the need for amputation. Around 80% of people who receive either type of surgery will not need to have an amputation.

An angioplasty has the advantage of having a faster recovery time than bypass surgery, although it may not be as effective in the long-term as bypass surgery.

Hyperbaric oxygen therapy

An alternative treatment for gangrene is hyperbaric oxygen therapy. During this treatment, you are placed in a specially designed chamber, which is similar to the decompression chambers that are used by deep-sea divers to avoid decompression sickness (the bends).

The chamber is filled with oxygen, which is administered at a much higher pressure (hyperbaric) than the normal level of oxygen in the atmosphere.

This results in high levels of oxygen being dissolved into the blood stream, leading to more oxygen being delivered to the gangrenous areas, which speeds up healing. Hyperbaric oxygen therapy also halts and reduces the spread of bacteria because they cannot thrive in an oxygen-rich atmosphere.

Hyperbaric oxygen therapy has proved to be effective in treating gangrene that results from infected diabetic foot ulcers. The treatment helps to reduce a person’s risk of amputation.

Evidence relating to the effectiveness of hyperbaric oxygen therapy in treating other types of gangrene is limited, and further research is required.

Reconstructive surgery

Reconstructive surgery using a skin graft may be a possible way of treating gangrene that has caused damage to your skin.

During a skin graft, the surgeon will remove healthy skin from another part of your body (usually a part that is normally under clothing and not seen), and they will then reconnect it (graft it) to the damaged area of skin.

Glossary

Tissue

Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.

Antibiotics

Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
view information about Gangrene on www.nhs.co.uk »

Grace Halliday an inspirational lady who’s book on Deep Lymphatic Therapy opens up a whole new world on treating gangrene. At 83 this lady wrote an interesting book and still wanted to learn about the human body.