A patient complains that one or more fingers  or the toes, perhaps a part of the hand or foot are cold, appear purple and shriveled, evoke a charateristic odour and present with loss of sensation but with severe pain in the adjoining living tissue, with or without secondary infection. It is a case of GANGRENE.

Mostly two type of gangrene are known. The most common form is invariably due to an arterial block. Extremities  become white, cold and anaesthetic. Soon the part becomes painful, gradually drying and becoming mummified. As thrombosis slowly extends up the limb, the gangrene spreads until a line of demarcation  forms where adequate blood supply is available. The most common type is senile gangrene , which is due to arteriosclerosis.

SYMPTOMS OF GANGRENE

When gangrene affects your skin, signs and symptoms may include:

• Skin discoloration — ranging from pale to blue, purple, black, bronze or red, depending on the type of gangrene 
• Swelling or the formation of blisters filled with fluid on the skin
• A clear line between healthy and damaged skin
• Sudden, severe pain followed by a feeling of numbness
• A foul-smelling discharge leaking from a sore
• Thin, shiny skin, or skin without hair
• Skin that feels cool or cold to the touch
• The affected tissue is swollen and very painful
• You're running a low-grade fever and generally feel unwell

A condition called septic shock can occur if a bacterial infection that originated in the gangrenous tissue spreads throughout  body. Signs and symptoms of septic shock include:

• Low blood pressure
• Fever, possibly, though temperature may also run lower than the normal 98.6 F (37 C)
• Rapid heart rate
• Lightheadedness
• Shortness of breath
• Confusion

CAUSES OF GANGRENE

Gangrene may occur due to one or some of the following causes:

• Lack of blood supply. Your blood provides oxygen, nutrients to feed your cells, and immune system components, such as antibodies, to ward off infections. Without a proper blood supply, cells can't survive, and your tissue decays.
• Infection. If bacteria thrive unchecked for long, infection can take over and cause your tissue to die, causing gangrene.
• Trauma. Wounds that are traumatic, such as gunshot wounds or crushing injuries from car crashes, can cause bacteria to invade tissues deep within the body. When such tissues are infected, gangrene can occur.

TYPES OF GANGRENE

• Dry gangrene. Dry gangrene is characterized by dry and shriveled skin ranging in color from brown to purplish blue or black. Dry gangrene may develop slowly. It occurs most commonly in people who have arterial blood vessel disease, such as atherosclerosis, or in people who have diabetes.

• Wet gangrene. Gangrene is referred to as "wet" if there's a bacterial infection in the affected tissue. Swelling, blistering and a wet appearance are common features of wet gangrene.

  It may develop after a severe burn, frostbite or injury. It often occurs in people with diabetes who unknowingly injure a toe or foot. Wet gangrene needs to be treated immediately because it spreads quickly and can be fatal.

• Gas gangrene. Gas gangrene typically affects deep muscle tissue. If you have gas gangrene, the surface of your skin may initially appear normal.

  As the condition progresses, your skin may become pale and then evolve to a gray or purplish red color. A bubbly appearance to your skin may become apparent, and the affected skin may make a crackling sound when you press on it because of the gas within the tissue.

  Gas gangrene is most commonly caused by infection with the bacterium Clostridium perfringens, which develops in an injury or surgical wound that's depleted of blood supply. The bacterial infection produces toxins that release gas — hence the name "gas" gangrene — and cause tissue death. Like wet gangrene, gas gangrene can be life-threatening.

• Internal gangrene. Gangrene that affects one or more of your organs, such as your intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked — for example, when your intestines bulge through a weakened area of muscle in your abdomen (hernia) and become twisted.

  Internal gangrene may cause fever and severe pain. Left untreated, internal gangrene can be fatal.

• Fournier's gangrene. Fournier's gangrene involves the genital organs. Men are more often affected, but women can develop this type of gangrene as well. Fournier's gangrene usually arises due to an infection in the genital area or urinary tract and causes genital pain, tenderness, redness and swelling.
• Progressive bacterial synergistic gangrene (Meleney's gangrene). This rare type of gangrene typically occurs after an operation, with painful skin lesions developing one to two weeks after surgery.

RISK FACTORS OF GANGRENE

Several factors increase your risk of developing gangrene. These include:

• Diabetes. If you have diabetes, your body doesn't produce enough of the hormone insulin (which helps your cells take up blood sugar) or is resistant to the effects of insulin. High blood sugar levels can eventually damage blood vessels, decreasing or interrupting blood flow to a part of your body.
• Blood vessel disease. Hardened and narrowed arteries (atherosclerosis) and blood clots also can block blood flow to an area of your body.
• Severe injury or surgery. Any process that causes trauma to your skin and underlying tissue, including an injury or frostbite, increases your risk of developing gangrene, especially if you have an underlying condition that affects blood flow to the injured area.
• Smoking. People who smoke have a higher risk of gangrene.
• Obesity. Obesity often accompanies diabetes and vascular disease, but the stress of extra weight alone can also compress arteries, leading to reduced blood flow and increasing your risk of infection and poor wound healing.
• Immunosuppression. If you have an infection with the human immunodeficiency virus (HIV) or if you're undergoing chemotherapy or radiation therapy, your body's ability to fight off an infection is impaired.
• Medications or drugs that are injected. In rare instances, certain medications and illegal drugs that are injected have been shown to cause infection with bacteria that cause gangrene.

COMPLICATIONS OF GANGRENE

Gangrene can lead to scarring or the need for reconstructive surgery. Sometimes, the amount of tissue death is so extensive that a body part, such as your foot, may need to be removed (amputated).

Gangrene that is infected with bacteria can spread quickly to other organs and may be fatal if left untreated.

PREVENTION OF GANGRENE

Here are a few suggestions to help you reduce your risk of developing gangrene:

• Care for  diabetes. If we have diabetes, make sure we examine our hands and feet daily for cuts, sores and signs of infection, such as redness, swelling or drainage. 
• Lose weight. Excess pounds not only put  at risk of diabetes but also place pressure on  arteries, constricting blood flow and putting  at risk of infection and slow wound healing.
• Don't use tobacco. The chronic use of tobacco products can damage  blood vessels.
• Help prevent infections. Wash any open wounds with a mild soap and water and try to keep them clean and dry until they heal.
• Watch out when the temperature drops. Frostbitten skin can lead to gangrene because frostbite reduces blood circulation in an affected area. If we notice that any area of  skin has become pale, hard, cold and numb after prolonged exposure to cold temperatures, call your doctor.

HOMEOPATHIC MEDICINE FOR GANGRENE

Anthracinum is a nosode which is a very valuable remedy in malignant or septic inflammations of connective or cellular tissues. It forms carbuncles, abscesses, boil-like eruptions and malignant ulcers. Gangrenous ulcers; ulcers have a black base on the lower limbs and produce an offensive discharge. Gangrene from burns and scalds. Patient is restless and debilitated.

Arsenicum album is specially for diabetic gangrene. Ulcers on the heels, soles, toes and finger tips, with burning pains, relieved by heat. Pains are maddening, burning like fire, hot needles or wires. Patient is restless and complains of great sudden weakness.\

Cantharis vesicatorias action is rapid and intense. The inflammation is violently acute or rapidly destructive in the mucous and serous membrance. Tendency to gangrene ulcerative pain in soles; burning in feet at night.

Lachesis mutus skin has a bluish- purplish appearance, blisters become dark with black edges. There is purpura with intense prostration. Capillaries are dilated and small  wounds bleed much. Ulcer- sensitive, burning, bleeding, leading to gangrene.

Secale cornutum is a vegetable nosode. It has an action on the vasomotor nerves where there is first contraction and then dilatation of blood vessels. It is a good remedy for traumatic gangrene, ameliorated from cold.

Tarantula cubensis is suited for severe septic conditions, alarming prostration, actrocious burning, sharp stinging pains and board like  hardness of affected parts. Severe inflammation and pain. Purplish hue to affected part with burning and stinging. Malignant suppuration; bluish abscesses.

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