Gangrene of the left foot, ICD code 10. Types, signs and treatment of gangrene of the lower extremities

Gangrene is usually called tissue necrosis that affects the legs or arms. Death occurs as a result of disruption of the blood supply to cells or complete hypoxia. The larger the area affected by the disease, the more difficult it is to recover. In ICD-10, gangrene of the foot is discussed in several sections.

Types of gangrene of the feet

Two main types of pathology are considered:

Dry. If the layers of organs are left without oxygen for a long time, hypoxia will occur and the process of cell destruction will begin. The function of a body area is completely impaired, sensitivity is lost. There may be no pain - it all depends on the severity of the disease. The border zone is clearly defined, dead and living areas are separated.
Wet. It develops both independently and as a complication of dry gangrene. Elements of the skin become necrotic, the demarcation zone is unclear and blurred. Inflammation during gangrene leads to intoxication of the body. The symptoms are pronounced and dangerous.

The most severe form is gas gangrene. It develops due to the entry of anaerobic microbes into the wound. The infection spreads reactively throughout the body and without surgical intervention leads to amputation of a limb or death.

Features of ICD-10 coding

The International Classification of Diseases, Tenth Revision, is based on the etiology of diseases and is divided into categories. Let's consider the sections to which gangrene of the foot can be classified.

I2 – necrosis of the distal leg caused by vascular damage.
E10-E14 – destruction of limb tissue in diabetes mellitus.
I73 – necrosis in various vascular pathologies.
A0 – gas gangrene.
L88 – pyoderma of a gangrenous nature.
R02 is an ICD-10 code for gangrene not classified elsewhere.

The division into sections is justified by the difference in the approach to diagnosis, treatment and prevention of the disease.

Gangrene of the foot

The disease begins acutely, and it is impossible to confuse it with another pathology. Organ cells swell and begin to become necrotic, irreversibly deteriorate and lose their functionality. In the first stages after removal of necrotic tissue, cells can still proliferate and recover.

Initially, the pain syndrome is insignificant, so patients do not immediately seek medical help. Gangrene develops quickly, is difficult to treat and is irreversible in its final stages.

Gangrene of the toes

Often the disease begins with the little finger. The fingers gradually turn black: the lesions initially look like small spots.

The reactive progression of the anomaly is facilitated by the possibility of gangrene spreading along the nerves. This fact makes the pathology especially dangerous: the process cannot always be tracked and stopped in a timely manner even by highly qualified specialists. The lower extremities are well innervated, so the disease has many ways of spreading (compared with the number of nerve fibers in the affected area). In severe cases, gangrene of the finger can lead to amputation of the entire limb.

Gangrene of other parts of the lower extremities

This phenomenon is accompanied by widespread necrosis. Diverse localization and etiology (atherosclerosis, diabetes, infection) makes diagnosis difficult. Pain syndrome appears in the later stages, which is why people most often turn to doctors at those stages of the progression of the disease when it is no longer possible to repair the damage.

It is worth understanding that the gangrenous process causes charring and cell death; it will not stop on its own. All layers of the skin are damaged. Blood circulation is severely disrupted.

Bedsores are common on the lower extremities and back. These are areas of necrosis caused by acute hypoxia due to strong compression of tissues by the weight of one’s own body. To avoid trouble, caregivers of a bedridden patient must understand the importance of prevention, frequent turning over of the patient and changing positions.

General symptoms include the following manifestations: severe weakness, dyspeptic disorders, increased temperature, fever, pale skin. The skin tone over the lesion site varies from purple to black.

Palpation reveals a pasty consistency, the spread of the disease occurs within hours. If left untreated, the patient dies from intoxication shock.

Diabetic gangrene

Diabetes mellitus is a common pathology associated with metabolic disorders. The disease can be of the first type, when insulin production is affected, and of the second, in which the problem lies in the membranes and channels of hepatocytes.

The main complication of diabetes is a change in the normal concentration of glycated hemoglobin, which leads to the destruction of the walls of blood vessels. Glucose becomes a trigger for the synthesis of increased amounts of glycosides and lipids. Plaques form, the lumen narrows, the supply of nutrients decreases, and hypoxia develops. Round small ulcers form on the skin, which threaten the development of necrosis.

Diabetic gangrene is characterized by:

Slow regeneration of damaged tissues.
Possibility of damage to blood vessels and nerves.
Involvement of bones in the process.

Gangrene progresses quickly and therefore requires urgent attention to a specialist. People with diabetes should closely monitor their health. At the initial stage, gangrene can be treated, and some tissues can recover. In case of late initiation of therapy, the consequences are very dire: from amputation of a limb or part thereof to death.

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Gangrene- this is the death of body tissues that have a connection with the environment, while the organ acquires a dark, black color. The disease is characterized by a severe course, threatens organ loss and is life-threatening for the patient.

Gangrene was a very common occurrence before the invention of antibiotics and various instrumental and laboratory diagnostic methods, especially during wars. Most limb injuries resulted in their loss. Gangrene also often developed in a hospital setting, as a postoperative complication and the result of a nosocomial infection.

Nowadays, when a huge number of antibiotics are available, this disease is also not uncommon. Thus, according to statistics, more than half of patients with insulin-dependent diabetes mellitus develop gangrene of the lower extremities within 20 years.

Interesting Facts!

Causes of gangrene development

There can actually be many reasons for the development of gangrene. But it all comes down to one thing - the lack of blood supply in the affected organ, as a result, oxygen does not enter the tissue, and without oxygen, necrosis, or tissue death.

Circulatory disorders (“ischemic gangrene”) most often develop in older people:

Diabetes mellitus is the most common cause of gangrene, and the lower extremities, namely the feet, are most often affected.
Atherosclerosis – in the obliterating form of the disease, an atherosclerotic plaque can completely block the lumen of blood vessels, preventing the flow of blood to the organ.
Obliterating endarteritis is an autoimmune vascular lesion that often develops in heavy smokers.
Blockage of blood vessels by a blood clot, and the blood clot can break off after surgery, bleeding, or childbirth.
Thrombophlebitis of the lower extremities.
Raynaud's disease is a syndrome of many diseases in which the innervation of blood vessels is disrupted (systemic lupus erythematosus, scleroderma, severe cervical osteochondrosis).
Myocardial infarction, ischemic stroke, pulmonary infarction and other diseases.

Impact of physical factors:

Frostbite of the extremities;
burns;
electric shock, including lightning.

Mechanical tissue damage:

Injuries and wounds in which the integrity of blood vessels and nerves is disrupted - gunshot wounds, wounds from shell fragments, road accidents, and so on;
bedsores of bedridden patients;
state after an “unsuccessful” operation;
prolonged compression of an organ - being under rubble, in a car after an accident, prolonged application of a hemostatic tourniquet or tight plaster bandage, wearing narrow rings, shoes, pulling unusual objects onto the penis, strangulation of a hernia, and so on.

Infectious pathogens of gangrene:

Anaerobic gas gangrene - the causative agent is the anaerobic bacteria clostridium;
Purulent diseases caused by staphylococci and streptococci: lung abscess, purulent appendicitis, peritonitis, etc.;
protea;
meningococcal infection (meningococcemia);
tuberculosis (with caseous pneumonia, pleural empyema);
leprosy or leprosy, and others.

Infections can cause gangrene with or without other factors that impair blood circulation (diabetes, wounds, burns, severe intoxication, etc.). In the presence of diabetes mellitus, even slight paresis and wearing tight shoes can lead to tissue necrosis.

Dry gangrene is the result of a long-term circulatory disorder under aseptic (without infection) conditions. This type of gangrene leads to mummification of the affected area, which over time can become detached from the body (amputated). Dry gangrene mainly affects the extremities. Often both limbs are affected, symmetrically. In most cases, dry gangrene does not threaten the patient’s life until infection occurs.

Wet gangrene is always a threat to the patient’s life, since infection is involved in the process. This type of gangrene occurs in the extremities, genitals, lungs, intestines and other internal organs.

Types of gangrene depending on the cause of development

Ischemic gangrene;
infectious gangrene;
anaerobic gas gangrene;
toxic gangrene;
allergic gangrene;
hospital gangrene (developing in a hospital, for example, after surgery).

ICD-10

The ICD is a classification generally accepted throughout the world that allows you to encrypt the diagnosis. This is necessary for statistical calculations, documentation, concealment of the diagnosis at the request of the patient and understanding of the diagnosis by foreign doctors.

Gas gangrene – A 48.0;
Gangrene associated with atherosclerosis – I 17.2;
Gangrene in diabetes mellitus – E 10.5 – E 14.5;
Dry or wet gangrene of the extremities – R 02;
Intestinal gangrene – K 55.0;
Lung gangrene – J 85.0;
Tooth gangrene – K 04.1;
Gangrene in Raynaud's disease – I 73.0.

How does gangrene develop? (pathogenesis)

Stages of development of dry gangrene
1. Long-term circulatory disorders (vascular diseases, ischemia) - cells do not fully receive the necessary oxygen, fluid and nutrients, and accumulate metabolic products.
2. Tissue necrosis or tissue death in an area where blood does not reach.
3. A protective reaction of the immune system, in which immune cells limit dead tissue from healthy tissue, and a clear inflammatory ridge is formed.
4. Mummification stage. There is a loss of fluid and drying out of dead tissue, the organ decreases in size and becomes black. Due to the small amount of liquid and the absence of pathogenic bacteria in the affected area, decay processes are inhibited, so a small amount of toxins is formed, which is not dangerous for the patient.
5. Progressive gangrene occurs over time, the body rejects dead tissue - amputation occurs.
6. When infection occurs at any stage, putrefactive processes, that is, wet gangrene, may develop.

Stages of development of wet gangrene
1. Acute cessation of blood supply to an organ (trauma, blood clot, frostbite, etc.).
2. Rapid development of tissue necrosis, sometimes lightning fast, within several hours.
3. Attachment of infection, development of an infectious inflammatory process.
4. Rapid decomposition of dead tissue (rotting): swelling, pain, darkening, increase in volume of the affected area.
5. Immune reaction - immunity cannot limit necrosis from healthy areas, infection spreads and large amounts of toxins enter the blood.
6. Toxins from bacteria and destroyed tissues, entering the blood, worsen the general condition and lead to disruption of the functioning of all organs and systems of the body. At this stage, in addition to toxins, bacteria can also enter the bloodstream - sepsis (blood poisoning) develops. Sometimes only a few hours pass before the development of multiple organ failure (failure of vital internal organs), which threatens the patient’s life.

Why does gangrene cause black skin?
Firstly, blood does not flow to the affected area, and it is this that gives the pink color to our skin. Secondly, decay products accumulate in the tissues, including hemoglobin (a blood protein that carries oxygen and carbon dioxide). The iron contained in it binds with sulfur, which is released from the destroyed tissue of the skin, muscles, and nails. Iron sulfide salt has a black metallic color in the absence of oxygen.

Symptoms and signs, photos

First signs. How does gangrene begin?

The heat exchange of the skin is disrupted, it becomes cold to the touch;
the sensitivity of the skin is impaired, a feeling of numbness appears in the affected area;
weakness and fatigue appear;
movements and their coordination are impaired; if it concerns the lower extremities, lameness appears; if the upper limbs, then everything falls out of hand;
pain and burning appear in the affected areas.

Dry and wet gangrene initially have common symptoms, the only difference is in the timing of their development. Dry gangrene begins gradually, slowly, sometimes over months and years, and the development of wet gangrene occurs over hours or several days. Further treatment depends on the type of gangrene - dry or wet.

Photo: signs of circulatory disorders in the fingers, Raynaud's syndrome.

Symptoms of dry gangrene of the extremities

With the development of dry gangrene, the fingers, hands or feet first acquire a bright red color or, conversely, they become cyanotic;
then the skin becomes pale, an unhealthy shine, marbling appears, the skin gradually darkens, acquiring a bluish tint, and then completely blackens;
all skin changes during dry gangrene develop from the peripheral parts to the center, to the place of cessation of blood circulation;
a clear boundary is visible between the area of gangrene and the healthy area - the contrast between black and pink skin, and a compaction is also determined - a demarcation ridge or demarcation shaft;
the affected limb decreases in size and becomes deformed;
unlike wet gangrene, there is no putrid smell;
the pain stops and any sensitivity in the affected limb disappears;
there is also no pulse;
with injury and infection of the affected limbs, dry gangrene can become wet, but in most cases this occurs in the initial stages of the disease, when the affected limb has not yet completely dried out.

Photo: dry gangrene of the fingers of the right hand is the result of circulatory problems after a stroke. The distal phalanges of the fingers are reduced in size, dry, black in color, they have been mummified, and there is a clear boundary between gangrene and healthy tissue.

Symptoms of wet gangrene of the extremities

The skin becomes pale, a vascular network of dilated veins appears;
swelling of the affected area appears, due to which it increases in size;
there are no boundaries between the gangrenous and healthy areas, gangrene can spread to other areas;
brown blisters form (due to filling with blood), which quickly open, and in their place wounds form - trophic ulcers, which have a dirty gray color;
when pressing on the bubbles, a characteristic crunch is heard - this is an accumulation of hydrogen sulfide - a product of the breakdown of soft tissues and muscles;
fetid rot is released from the ulcer;
all these manifestations are accompanied by a violation of the general condition, which is associated with intoxication by the decay products of bacteria and necrosis of one’s own tissues.

Photo: wet gangrene of the right foot with “diabetic foot”. An atrophic ulcer with a dirty color is detected, there is cyanosis around it, the skin of the foot is glossy and turns black.

Features of pain with gangrene

For dry gangrene The pain is tolerable at first, then its intensity intensifies, becoming strong, acute, and debilitating. They do not stop after taking conventional painkillers; they often require strong and even narcotic drugs, which also may not alleviate the torment. The pain is especially worse at night. The patient often takes a forced position, grasping and pinching the affected areas. The condition is alleviated by raising or lowering the limb; for some, it becomes easier while walking.

The pain stops only after complete necrosis of the limb, that is, after it has completely blackened. In some patients, after complete death of a limb, phantom pain may appear - pain in a limb that does not exist (after amputation), scientists still cannot explain this phenomenon. Phantom pain is almost impossible to stop.

For wet gangrene the pain appears suddenly, it is acute and also does not stop after taking strong analgesics. There is an opinion that after the onset of pain due to circulatory problems, the patient and the doctor have only a few hours to prevent the organ from dying. With the appearance of ulcers and rotting of a limb or organ, the pain in most cases does not stop, which is associated with the spread of rotting to other areas.

Temperature and intoxication

With dry gangrene, there are usually no symptoms of intoxication, the general condition of the patient is good or slightly impaired, weakness and fatigue are possible.

But with wet gangrene, intoxication gains momentum, the patient’s general condition deteriorates sharply and is serious. In rare cases, wet gangrene occurs without pronounced symptoms of intoxication, but this does not mean that gangrene is mild and has a good prognosis.
Symptoms of intoxication in a patient with wet gangrene:

increase in body temperature to high numbers, sometimes up to 40-41 o C;
severe chills, tremors of extremities;
rapid heartbeat, more than 90 per minute;
blood pressure drop below 90/60 mm Hg. Art.;
severe weakness, the patient cannot get out of bed;
possible confusion, delirium, convulsions;
with severe intoxication and the development of sepsis, other organs are also affected: the brain, kidneys, liver, heart, lungs, blood vessels, a blood clotting disorder occurs - bruises and hemorrhages appear, the patient may die from multiple organ failure (failure of vital organs).

Features of the course of some forms of gangrene

Anaerobic gas gangrene

The causative agent of gas gangrene is Clostridium bacteria.

The genus Clostridia includes the causative agents of botulism and tetanus. All these bacteria secrete strong poisons - toxins.

Microbiology of clostridia

Kingdom	Bacteria
Type	Firmicutes
Class	Clostridia
Genus	Clostridia
Kinds, causing gangrene	Clostridiumperfingens – causes almost all cases of gas gangrene, Clostridium septicum Clostridium histolyticum, Clostridium oedematiens
Bacteria shape	spindle sticks
Dimensions	Length – 2 – 10 microns, width – 0.5 – 1.5 microns.
Gram stain	Gram-positive bacteria
Growth on nutrient media – sowing to obtain a bacterial culture.	Milk + glucose + blood agar, temperature 37 o C. The beginning of growth is 18-20 hours, obtaining a culture is 5 days.
Conditions for reproduction	Lack of oxygen, that is, these are anaerobic bacteria. In the process of life they produce a large amount of gases, *hence the name – gas gangrene.*
Source of infection	Human and animal feces.
Who is affected?	People; rabbits, guinea pigs; large and small livestock; other mammals.
Prevalence and persistence in the environment	Bacterial spores persist in the soil and can live there for many years. Clostridia themselves are unstable in the environment and die.
Gate of infection	Extensive, deep, contaminated wounds, as well as when foreign objects enter the wound.
Toxins	It produces a large number of toxins, at least 13. All these substances are very dangerous poisons; when they are introduced into the blood of laboratory animals, rapid death is observed.

Features of the course of gas gangrene:

it is always wet gangrene;
the presence of large bubbles containing blood and gases formed during the life of clostridia;
when pressing on the skin, a special crunch is heard;
always severe intoxication;
very fast and progressive course.

Photo: gas gangrene of the left leg. The limb is dark in color, swollen, there are large blisters with brown contents and ulcers on the foot.

Forms of gas gangrene:
1. Emphysematous form – characterized by increased formation of gas-containing bubbles, sometimes their sizes reach more than 10 cm in diameter.
2. Edema-toxic form – swelling of the affected organ and intoxication predominate, blisters are small and isolated.
3. Mixed form– this is a combination of clostridia with a coccal infection (staphylococci, streptococci). This form is especially severe, characterized by rapid putrefactive processes and the spread of infection over large areas.

Fournier's gangrene

Fournier's gangrene is necrosis of the scrotal tissue; usually this form of gangrene occurs violently, lightning fast, and always threatens the patient's life.

Necrosis of the scrotum occurs as wet gangrene due to infection of the tissues by various bacteria. Typically, gangrene occurs after injury to the external genitalia.

Symptoms of fulminant gangrene of the scrotum:

pain, redness, swelling in the scrotum area;
increased pain syndrome;
the skin of the scrotum becomes black;
ulcers appear with purulent discharge;
severe intoxication.

The prognosis for Fournier's gangrene is unfavorable. In half of the cases, patients die without timely treatment.

Intestinal gangrene

Intestinal gangrene is also, in most cases, the result of circulatory disorders in the intestinal vessels (ischemia, thrombus, wounds and trauma). Gangrene can also occur during an infectious process, for example, with peritonitis, intestinal obstruction, purulent appendicitis, tuberculosis of the mesenteric lymph nodes, and so on.

Symptoms of intestinal gangrene:

sudden onset;
sharp, unbearable pain in the abdomen;
weakness;
blood pressure drops below 90/60 mmHg. Art.;
increased heart rate above 90 per minute;
thready pulse;
possible disturbance of consciousness, up to its loss;
vomit;
diarrhea or constipation; stool may contain blood;
when listening to intestinal peristalsis (motility), you can hear pulsation in the abdominal area;
after 2 hours, symptoms of intoxication intensify.

If intestinal necrosis occurs, surgery is urgently required; this threatens the patient’s life. A favorable prognosis is possible if surgical treatment is performed within 2 hours from the onset of the first symptoms.

Photo: This is what intestinal necrosis looks like due to thrombosis of mesenteric vessels.

Gangrenous cholecystitis

Gangrenous cholecystitis is necrosis of the gallbladder. The main cause of such gangrene is gallstones.

Symptoms of gangrenous cholecystitis:

usually acute onset;
severe abdominal pain, which can radiate to the chest, under the shoulder blade, to the lumbar region, to the right shoulder, the pain intensifies when lying on the right side;
pronounced symptoms of intoxication: temperature above 39-40 o C, severe weakness, headache, and so on;
nausea and vomiting not associated with food intake;
bloating;
On examination, sharp pain is observed in the area of the right hypochondrium.

Necrosis of the gallbladder must be differentiated from myocardial infarction, peritonitis, acute appendicitis, and even renal colic.

Gangrenous cholecystitis also requires urgent surgery and threatens the development of purulent peritonitis and sepsis.

Gangrenous appendicitis

Gangrenous appendicitis is partial necrosis of the appendix (appendix). The main reason for such necrosis is acute appendicitis, which was not promptly recognized and operated on. In rare cases, the cause of gangrenous appendicitis is atherosclerosis.

Symptoms of gangrenous appendicitis:

usually gangrene of the appendix occurs 2-3 days after the onset of symptoms of acute appendicitis;
pain in the left iliac region, which is characteristic of acute appendicitis, subsides;
severe vomiting begins, which exhausts the patient; blood may be present in the vomit;
symptoms of intoxication are expressed (the patient’s serious condition, increased heart rate, decreased blood pressure), but the body temperature is normal, this is a characteristic syndrome for gangrenous appendicitis - “toxic scissors syndrome.”

If the cause of gangrene of the appendix is a circulatory disorder, then pain and intoxication come to the fore, and the body temperature will be high (above 39-40 o C).

Gangrenous appendicitis requires urgent removal of the appendix, as it threatens the development of peritonitis, sepsis, and intestinal gangrene.

Photo: removed appendix for gangrenous appendicitis.

Abscess and gangrene of the lung

Lung gangrene is a very serious disease that can result in the death of the patient from sepsis, shock, pulmonary hemorrhage, respiratory and heart failure.

Causes of lung gangrene:

pulmonary embolism (PE) – blockage of pulmonary vessels by a blood clot;
lung abscess - a purulent disease, a complication of bacterial pneumonia;
penetrating gunshot or knife wounds into the chest cavity, fracture of ribs with displacement of fragments;
foreign bodies in the bronchi, including aspiration of vomit;
purulent pleurisy;
sepsis – infection through the blood or septic pneumonia;
pulmonary tuberculosis: caseous pneumonia, fibrous-cavernous tuberculosis, pleural empyema.

Photo: pathological material, lung gangrene.

Symptoms of lung gangrene:

the development of gangrene of the entire lung is possible, since necrosis very quickly spreads to healthy tissue, but there are cases of bilateral total gangrene, this condition is incompatible with the life of the patient;
sharp sharp pains on one side of the chest, aggravated by deep breathing and any movement, coughing, sneezing and even talking;
severe shortness of breath - difficulty inhaling and exhaling;
intense symptoms of intoxication, the patient’s condition is severe and extremely serious;
a painful cough with dirty, dark-colored sputum that has a foul, putrid odor;
possible hemoptysis or pulmonary hemorrhage;
the skin becomes sharply pale, bluishness of the skin of the face and limbs is observed;
symptoms of heart failure appear (low blood pressure, increased heart rate, swelling, and so on);
Infectious toxic shock may develop (drop in blood pressure, lack of urine, rashes and bruises).

Diagnostics

Usually, to diagnose gangrene of the extremities, an experienced doctor only needs to examine the patient. But still, to diagnose the type of gangrene, the reasons for its development, assess the general condition of the patient, the presence of complications and to determine the treatment method, additional types of research are required. It is more difficult to determine gangrene of internal organs, and laboratory and instrumental methods are indispensable, and sometimes a biopsy of the affected organ is required.

Laboratory research methods for gangrene

Research method	Type of gangrene	Pathological changes
General blood analysis	Dry gangrene	In most cases, there are no pathological changes; the ESR may be slightly accelerated. With atherosclerosis and thrombosis - an increase in the number of platelets (more than 320 G/l)
General blood analysis	Wet gangrene	Significant increase in leukocytes (more than 9 G/l); acceleration of ESR (more than 20 mm/h); increase in the level of band neutrophils (more than 5%); possible appearance of basophils (1-2%); decrease in the number of lymphocytes (less than 27%); increased platelet level (more than 320 G/l).
Blood chemistry	All types of gangrene	*Increased blood sugar levels* with diabetes mellitus (more than 5.5 mmol/l); *promotion* cholesterol in atherosclerosis (above 8 mmol/l); *significant increase in AST levels* (aspartate aminotransferase) – several times (especially in the initial stages of gangrene); *decrease in level* albumin (less than 20 g/l) and *increase in globulin levels* (over 36 g/l); *increased fibrinogen levels* (above 4 g/l); *high levels of C-reactive protein, sialic acids, seromucoid* characteristic of wet gangrene.
Blood for sterility	Wet gangrene	Bacteria in the blood are detected when sepsis or blood poisoning develops. Be sure to determine the type of pathogen and its sensitivity to antibiotics.
Bacteriological culture of wound contents	Wet gangrene	They take a scraping from the ulcer, then sow it on nutrient media, isolate the pathogen and determine its sensitivity to antibiotics, this is necessary for the correct selection of treatment.
Sputum analysis: microscopy; bacterial culture.	Lung gangrene	Increased level of white blood cells; the presence of red blood cells and “dead” tissue in the sputum; identifying bacteria, including tuberculosis, it is necessary to find out sensitivity to antibiotics.

Instrumental research methods for gangrene

Type of study	Form of gangrene	Description of possible changes
Radiography	*Gas gangrene of the extremities* Photo: gas gangrene of the left foot.	X-rays of the extremities with gas gangrene show multiple gas bubbles of different sizes. Conventional radiographs provide sufficient information. But if bone damage is suspected and to determine the level of necrosis of the limb, computed tomography (CT) will be more informative, especially in preparation for surgery.
Radiography	*Lung gangrene* Photo: Plain X-ray of the chest cavity with gangrene of the right lung.	On radiographs of the chest organs, an area of darkening is visible, which occupies 1-2 lobes or the entire lung, the affected lung is reduced in size, areas of clearing are noted - necrosis cavities, and levels of pus in them are often visible.
Bronchoscopy	*Lung gangrene* Photo: bronchoscopy for gangrene of the lungs.	When examining the bronchi using a bronchoscope, the bronchus and pus are blocked by “dead” tissue. This is the main criterion for diagnosing pulmonary gangrene.
Ultrasound of the chest cavity	*Lung gangrene*	Ultrasound for pulmonary gangrene is used to determine the dynamics during treatment in order to minimize radiation exposure. This method allows you to assess the presence of cavities of decay of lung tissue, the level of pus in them, as well as the presence of pus or other fluids in the pleural cavity.
Angiography – examination of blood vessels by introducing a special catheter and a contrast agent into them, the result is scanned using fluoroscopy (the image is displayed on the screen).	Photo: CT arteriography for pulmonary embolism.	In case of gangrene, angiography reveals areas of vessels that are narrowed or blocked by a thrombus. This study is necessary to determine the causes of the development of gangrene and the tactics of future treatment. This study requires hospitalization of the patient, there are risks associated with the effects of contrast and radiation exposure. With a CT scan, the radiation dose is greater than with conventional radiography.
CT arteriography – This is a type of angiography in which the result is assessed using computed tomography.	Photo: CT arteriography for pulmonary embolism.
Doppler ultrasound or duplex ultrasound scanning of blood vessels– examination of blood vessels using ultrasound.	*Gangrene associated with poor circulation*	Ultrasound also allows you to assess the patency of blood vessels and the volume of blood flow through them. A safer method than angiography, as it is performed without x-rays and the introduction of a contrast agent. An ultrasound can examine the lumen of the vessel, its inner wall, and even the atherosclerotic plaque that has blocked the vessel. But this method is inferior in visualization to angiography.
Diagnostic laparoscopy and thoracoscopy with biopsy of the affected organ	*Gangrene of internal organs* (lungs, intestines, gall bladder, appendix, heart and so on). Photo: laparoscopy for gangrenous appendicitis.	This is an invasive (penetrating into the body, traumatic procedure) method. To do this, they make punctures in the chest or abdominal cavity, insert an endoscope there and look on the screen to see what is happening to the internal organ, whether there is necrosis there. Using special instruments, the surgeon takes a biopsy of the affected areas. The resulting biopsy is examined by pathologists who make a conclusion about the diagnosis and the possible cause of the disease. If necessary, diagnostic laparoscopy can become therapeutic, that is, it is possible to remove dead tissue or restore vessel patency (stenting, bypass).

Complications and consequences of gangrene

Gangrene is a serious pathology that usually does not go away without a trace and has a high risk of developing complications that threaten the patient’s life.

Spread of gangrene over large areas
If wet gangrene is not treated in a timely manner, necrosis quickly spreads to healthy tissue. So, if the foot is affected, after a few days gangrene may develop up to the level of the knee. This increases the risk of developing other, more severe complications, including sepsis.

Sepsis, or blood poisoning
Sepsis can occur with wet gangrene, when bacteria and their toxins enter the bloodstream en masse and spread throughout the body. This condition is life-threatening; the patient may die from toxic shock, cerebral edema, or septic endocarditis (heart damage).

The main signs of developing sepsis:

high fever;
drop in blood pressure;
the appearance of rashes throughout the body in the form of bruises;
convulsions;
disturbance of heart rhythm and breathing;
confusion or loss of consciousness and other symptoms.

With the development of sepsis, powerful antibiotic therapy and detoxification are necessary, and the issue of removing organs affected by necrosis is also resolved.

Limb amputation
With dry gangrene, the limb dries out (mummifies) and over time may “fall off” on its own. But more often surgical amputation occurs, which is carried out in order to save the patient’s life.

Transition from dry gangrene to wet gangrene
Dry gangrene, especially at the onset of the disease, can be complicated by the addition of bacterial flora. This is manifested by the presence of intoxication and the spread of gangrene to overlying tissues, that is, the boundary between dead and healthy tissues ceases to be defined.

Peritonitis and intestinal obstruction
This complication often develops with gangrene of the intestine, appendix and gallbladder. In this case, the infection from the affected organs passes to the serous membrane of the abdominal cavity. Without surgical treatment, this condition can lead to the death of the patient.

Treatment

Gangrene is always an indication for hospitalization in the surgical department of a hospital. Treatment of gangrene must be started urgently.

It is quite difficult to cure this condition. Treatment is always comprehensive, aimed at preserving the patient’s life, the cause of the development of gangrene, restoring blood circulation and preventing the spread of the process.

The amount of treatment directly depends on the type of gangrene.

Treatment of dry gangrene

1. Anesthesia, novocaine blockades.
2. Drugs that improve blood circulation: Actovegin, Neuroxone, Piracetam, Cinnarizine, Nicotinic acid, Pentoxifylline (Trental), Vazaprostan, Reopoliglyukin, Perftoran and other infusion solutions.
3. Drugs that destroy blood clots: Streptokinase, Actilyse, Retavase, Levostor, Aspirin, Heparin, etc.
4. Oxygen inhalation.
5. Surgery:

intravascular (endovascular) operations;
bypass surgery and stenting of blocked vessels;
amputation of dead tissue - affected limbs are routinely removed above the demarcation line from healthy tissue.

Treatment of wet gangrene

1. Antibacterial therapy.
2. Surgical treatment – removal of all “dead tissue”, amputation if necessary.
3. Detoxification therapy: intravenous infusion of various solutions.
4. Diuretics.
5. Treatment of concomitant diseases: insulin therapy for diabetes, drugs that improve blood circulation, hormones, and so on.

Treatment of gas gangrene

1. Surgical treatment - removal of affected tissue or amputation, local surgical treatment of the wound, access to fresh air for the wound (it is not recommended to bandage the wound).
2. Hyperbaric oxygen therapy - placing the injured limb in a pressure chamber under high oxygen pressure. Oxygen is detrimental to clostridia, the causative agent of gas gangrene.
3. Antibiotics.
4. Antigangrenous serum is a drug containing antibodies to the main types of clostridia.

Treatment of gangrene of the lung, intestines, gangrenous cholecystitis and appendicitis

Treatment of lung gangrene:

Antibiotics intravenously and intramuscularly.
Introduction of antibiotics and antiseptics into the bronchi using a bronchoscope.
Detoxification therapy – intravenous drip administration of solutions.
Drugs that dilate the bronchi: inhalations of Salbutamol, Ventolin, Berodual, injections of Eufillin.
Drugs that enhance immunity.
Surgical treatment: removal of part or amputation of the entire lung when a lung abscess (ulcer) forms, freeing the pleural cavity from pus. Surgical treatment is resorted to only if there is no effect from drug therapy.

Treatment of intestinal gangrene:

urgent surgery to remove the affected area of the intestine;
antibiotics.

Treatment of gangrenous cholecystitis and appendicitis:

surgical removal of the affected organ;
antibiotics.

Use of antibiotics

Indications for antibiotic therapy are any wet gangrene.

Considering that with tissue necrosis there is usually not just one type of bacteria, but a whole spectrum, antibiotics must act on all possible microorganisms, so not one antibiotic, but two or even more are often prescribed. The drugs are administered in the form of intravenous or intramuscular injections, and maximum doses are used. Recently, the method of administering antibiotics inside the lymphatic plexuses and vessels has proven itself to be successful.

The most commonly used antibacterial medications to treat gangrene are:

Use of painkillers
Painkillers are used for any type of gangrene, as patients suffer from unbearable pain. But, unfortunately, even narcotic drugs are not able to alleviate the patient’s suffering, as surgeons joke: “The best pain reliever is amputation.”
Types of pain relief for gangrene:
1. Narcotic drugs (Morphine, Tramadol, Omnopon) have a good short-term effect, but their use can develop drug addiction, especially with long-term use.
2. Non-narcotic painkillers (Analgin, Ibuprofen, Dexalgin) have a very weak and short-term effect.
3. Novocaine blockades - the affected areas are injected with novocaine. This method not only reduces the intensity of pain, but also dilates blood vessels, improving their patency.
4. Epidural anesthesia is the injection of anesthetics into the spinal canal. Suitable for gangrene of the lower extremities and scrotum.
5. Physiotherapy – neurostimulation of the spinal nerves.
Ointments for gangrene
In traditional medicine, ointments are rarely used to treat gangrene, since they may not only not help, but also cause harm.
Among those used, ointments containing antibiotics or antiseptics can be distinguished. These are Vishnevsky ointment, Levomekol, Iruksol, Solcoseryl. But these ointments cannot be used alone; they can help in combination with other treatment methods.
Surgical operations for gangrene, main types
1. Endovascular (intravascular) operations: aimed at restoring the patency of a blood vessel:
- Thrombolysis is the removal of a blood clot blocking a vessel.
- Stenting is the installation of a special device - a stent - into the lumen of a narrowed vessel, which becomes a kind of frame for it, through which blood circulates unhindered.
- Bypass surgery is the creation of an artificial vessel through which blood can circulate to bypass the blocked vessel.
- Vascular prosthetics is the replacement of a non-functioning vessel with an artificial prosthesis or a transplanted vessel.
2. Necrectomy– excision and removal of “dead” tissue, can only be used for shallow necrosis of the skin and soft tissues. This operation allows you to save the limb, but increases the risk of complications.

3. Amputation of a limb– removal of the limb above the affected areas followed by the formation of a stump. Amputation is necessary in case of rapidly progressing gangrene, lack of effect from other treatment methods, and is carried out for health reasons. After complete formation of the stump, limb prosthetics is possible.
Is it possible to cure limb gangrene without amputation?
Half of patients with gangrene undergo amputation of the affected organ. Amputation is not a whim of a surgeon, but an event aimed at saving a life; this is the last thing a doctor resorts to when nothing else helps. It can be avoided with timely consultation with a doctor, a good response to drug treatment, and the elimination of factors that worsen blood circulation in the affected organ.
How to cure gangrene at home? Traditional methods of treatment
Gangrene is not treated at home, as this disease threatens the patient’s life. Every hour counts, the more time of inactivity, the higher the level of amputation. There is no time to experiment with herbs and other traditional medicine.
Traditional medicine will come to the rescue in combination with other traditional methods of treatment, but these should be means that increase the body's defenses, containing useful substances, vitamins and microelements.
Gangrene of the leg (diabetic foot): surgical treatment without amputation - video

Forecast
Prognosis for dry gangrene relatively favorable, since such necrosis does not threaten the patient’s life. Although, if we consider the ability to work, then, of course, dry gangrene leads to the loss of a limb and disability. In addition, dry gangrene can develop over time on the second limb, in a symmetrical area.
For wet gangrene half of the patients are left without a limb, and amputation is performed significantly above the affected segment. There is also a very high risk of developing sepsis and death of the patient, especially if adequate treatment is started late.
It is not possible to restore dead tissue, so the goal of treatment is to stop the process and prevent the development of complications.
How long do people live with gangrene?
Dry gangrene does not affect life expectancy and rarely causes the death of the patient. However, the patient may die from diseases that cause the development of gangrene, for example, from obliterating atherosclerosis, heart attack, stroke.
With wet gangrene, a person can survive for three days or even less without treatment. Therefore, every hour counts.
Prevention of gangrene
1. Proper nutrition, an active and healthy lifestyle - prevention of atherosclerosis and other vascular diseases.
2. Timely treatment of diseases that impair blood circulation, complete rehabilitation after strokes and heart attacks.
3. Prevention and adequate treatment of diabetes mellitus, timely initiation of insulin therapy.
4. Mandatory treatment of various wounds.
5. Avoiding burns and frostbite of the extremities.
Answers to frequently asked questions
Gangrene in diabetes mellitus. What are the features of sugar gangrene?
Diabetes mellitus is one of the main causes of gangrene. Most often, wet gangrene develops, since “sweet blood” is a good breeding ground for many bacteria. For the same reason, treatment of sugar gangrene is always difficult and in most cases leads to amputation of the limb.
In diabetes, the most typical gangrene of the foot is diabetic foot, the most severe complication of diabetes mellitus.
Why does diabetic foot develop in diabetes mellitus?
1. Angiopathy– in diabetes, excess sugar over time damages and destroys the wall of small arteries and arterioles, which leads to poor circulation and oxygen deficiency of body tissues. In addition to the foot, the vessels of the retina and kidneys are often affected.
2. Reduced skin sensitivity – Sugar also negatively affects the nervous system. Diabetics often do not feel cold, heat, or pain; patients may grab a hot pan and not understand it. Therefore, when a circulatory disorder begins, they do not have a symptom of pain, which leads to a later visit to the doctor.
3. Diabetes mellitus disrupts all types of metabolism , including fat, that is, diabetics often suffer from atherosclerosis even at a young age.
4. Diabetes has reduced immunity Therefore, various bacterial infections are often observed; microbes thrive in a sweet environment.
5. The triggers for the development of diabetic foot are:
- wearing tight shoes;
- frostbite – diabetics often do not feel the cold;

Alphabetical index. gas gangrene (A48.0) . pyoderma gangrenous (L88).

Relevance of the classifier: 10th revision of the International Classification of Diseases.

telephone city codes, telecom operators, postal codes, GOSTs and all-Russian classifiers.

Coding of foot gangrene according to ICD 10

Gangrene is not an independent diagnosis, but is a complication of a pathological process.

Due to this feature of the nosological syndrome, gangrene of the foot according to ICD 10 has a code that depends on the etiological factor.

The gangrenous process is the state of tissue necrosis in any part of the human body, but more often the pathology affects the lower extremities, in particular the feet.

Necrotic phenomena develop due to insufficient oxygen supply to tissues or a complete lack of oxygenation. First, a trophic ulcer develops in the area of hypoxia, which gradually progresses to full-fledged necrosis.

Tissue necrosis can be dry or wet, depending on the clinical picture. The first type is characterized by painless necrosis of the skin and deeper layers, without the release of liquid pus. Wet gangrene develops when infectious agents enter an area of dry necrotic tissue, resulting in the formation of weeping areas with purulent contents.

Encoding Features

Gangrene of the foot in ICD 10 is encrypted depending on the etiological factor. The pathological process can be located in different categories and even classes, since there are many causes of necrosis. The following types of necrosis of the foot are classified:

I2 – atherosclerotic necrosis of the distal lower limb;
E10-E14 – necrosis of the finger and foot caused by diabetes mellitus, with a common fourth sign;
I73 – necrotic phenomena in various pathologies of the peripheral vascular network;
A0 – the most dangerous, gas gangrene;
L88 – pyoderma of a gangrenous nature;
R02 – tissue necrosis of the lower extremity, not classified elsewhere.

This division of necrotic changes in the foot is due to different approaches to the diagnosis and prevention of a dangerous condition. Therapeutic measures always remain the same - necrosis is an irreversible condition, so dead tissue is removed surgically, often through amputation of the foot or its individual parts.

Prevention Approaches

Of various etiologies, gangrene in the international classification of diseases is considered one of the most unfavorable complications of any pathological process. The disease is inherently incurable and requires drastic measures to save the patient’s life. Therefore, gangrenous changes are easier to prevent by applying the following principles of prevention:

correct primary surgical treatment of a contaminated wound;
timely detection of diabetes mellitus and maintaining it in a compensated state;
treatment of atherosclerosis and heart failure;
early detection and emergency treatment of various types of vascular occlusion: thrombosis, embolism, inflammation and so on;
treatment of bacterial pathologies of a dermatological nature.

The appearance of gangrenous changes in a patient indicates a lack of consciousness of the patient (ignoring symptoms, self-medication, failure to follow doctor’s recommendations) or the inattention of a doctor who missed the onset of the necrotic process. By adhering to protocols for the diagnosis and treatment of diseases leading to gangrene, it is highly likely to avoid the development of a dangerous complication.

Types, signs and treatment of gangrene of the lower extremities

Gangrene of the lower extremities, like, in fact, any type of tissue necrosis, is a rather dangerous manifestation that can put a person’s life at risk. It occurs due to limited oxygen supply to the tissues or its complete cessation. The affected area is usually quite distant from the heart: the legs as a whole or part of the toe. Due to the lack or absence of oxygen, an irreversible process of cell death begins.

Various causes of necrosis have been cited, from severe frostbite to chronic pathologies such as diabetes. Thrombosis of blood vessels also often becomes the “causative agent” of gangrene.

Why does cell death occur?

The causes of necrosis can be both external and internal influence factors.

External:

mechanical damage to the skin, blood vessels, nerve endings;
bedsores;
low temperature – as a result, frostbite;
high temperature leading to burns;
aggressive chemical exposure;
radiation contamination.

Internal:

damage to blood vessels, leading to deterioration of metabolic processes in tissues;
changes in the anatomy of the elements of the circulatory system (thickening of the walls of blood vessels, the formation of plaques with a gradual narrowing of the lumen until it is completely blocked);
diabetes mellitus, Raynaud's syndrome, vibration disease, etc.;
abuse of fatty foods.

The blood can no longer supply oxygen and essential nutrients to the tissues in sufficient quantities. Gradually, the death of individual cells occurs with progressive localization.

Types of gangrene

There are two main forms of gangrene.

Dry. It develops against the background of too rapid cessation of oxygen supply to cells. The fabric dries out, wrinkles, and decreases in size. This is primarily caused by the breakdown of blood elements and the coagulation of proteins. Outwardly, it looks like mummified remains. The functions of a finger or toe are completely lost. The sensitivity of the skin disappears. The patient experiences ongoing pain in the injured limb, localized at the site of gangrene formation. Tissue death gradually spreads along the leg. The skin of the bordering zone becomes inflamed. Dead tissue is rejected. The most common is dry gangrene of the toe(s).

One of the forms of gangrene is dry

Gas gangrene is considered a severe wet form. This form was often found on the battlefield when anaerobic infection (from the soil or dust) entered the untreated wounds of soldiers. The infection spread quickly, and without surgical help - treatment through immediate amputation - the patient did not have long to live.

ICD 10 (International Classification of Diseases, 10th revision) describes all currently known human diseases. ICD 10 also has a paragraph on necrosis, with a subparagraph on gangrene. In ICD 10 you can find several references to this disease:

Symptoms

External symptoms of tissue condition provide the first understanding of the type and shape of the lesion. The first signs may reveal themselves due to the development of obliterating atherosclerosis (gradual blockage of blood vessels). Acute arterial thrombosis provokes the development of gangrene rapidly. Sharp pain symptoms require immediate response.

It all starts with the appearance of a bluish spot on the leg. It grows, changes color, turning into darker shades, to black.

Symptoms of the dry form:

an area with dark-colored dead tissue;
the boundary between healthy and dead flesh is clearly visible;
there is no fever or other symptoms of general deterioration in the body’s condition;
pain symptoms vary in intensity.

Symptoms of the dry form of gangrene of the lower extremities

Symptoms of the wet form:

blackening of the integumentary tissue in the affected area;
lack of a clearly defined boundary between infected and uninfected tissues: black turns into purple-blue;
swelling;
general redness of the skin on the affected leg;
increased body temperature, possible rapid deterioration of the patient’s general condition;
rapid expansion of the localization zone.

The following symptoms are also observed:

signs of numbness, loss of sensitivity;
excessive (waxy) pallor of the affected skin area;
rapid fatigue of the leg when walking;
constant feeling of frozen feet, even in summer;
convulsions;
the formation of non-healing ulcers on the skin, which, in fact, are symptoms of the onset of gangrene;
The pain that is felt at the initial stage is not so sharp, the further you go, the sharper and more intense.

Gangrene must be treated. It will not go away on its own: the wounds will not heal, the skin will not recover. Failure to respond (that is, lack of adequate treatment) is fraught not only with a worsening of the patient’s condition, but also with more disastrous outcomes. Note that gangrene caused by internal causes is more difficult to experience and more difficult to treat.

Preventive and therapeutic effects

Experts say that it is more effective to treat gangrene surgically. Depending on the size of the affected area, stage and form of manifestation, minimal or radical amputation of the dead areas can be performed.

Cardinal amputation of dead areas with gangrene

It is worth saying that gangrene can be prevented (then you won’t have to treat it). For example, there are a number of diseases that can be complicated by soft tissue necrosis:

cardiac and vascular;
acute surgical;
traumatic and post-traumatic;
endarteritis, etc.

Consequently, here the first step is to prescribe adequate treatment for the underlying disease, which undoubtedly reduces the risk of gangrene formation.

So what is the effective treatment for this disease? Dead tissue cannot be restored. This means that the only correct way is to remove these tissues. Treatment should be prompt to prevent necrosis from spreading throughout the body and affecting large areas of the limb.

In the case of wet infectious gangrene, treatment will be required to quickly eliminate the infection in order to prevent intoxication of the body. So, in the wet form, partial or complete amputation of the organ is prescribed immediately. But treatment of dry gangrene can be postponed until dead tissue is completely limited.

As stated above, the wet form is more dangerous than the dry form. The first step is to transfer necrosis from one state to another. Alcohol dressings are applied to the patient on the affected areas. And then the unhealthy flesh is surgically cut off along the line of contact of necrosis.

How many will be removed? Depending on the form of manifestation, the size of the affected area. And yet, treatment is carried out in such a way as to preserve tissue as much as possible, followed by restoration of blood supply to the affected area. Treatment of gangrene is the prerogative of a vascular surgeon. Bypass surgery, stenting, vascular replacement, and thromboendarterectomy are often used. These methods of therapy have a number of contraindications, in particular, such operations are not recommended for patients of advanced age, as well as for serious cardiovascular diseases.

Mandatory prescription: antibactericidal, anti-inflammatory, painkillers. As well as treatment aimed at improving microcirculation in the limb.

The first stages of pathology development are easier to overcome. Here can be assigned:

physiotherapy;
taking antibiotics;
use of special external agents;
pneumopressotherapy.

With a progressive disease it is more difficult. Don’t hesitate to seek qualified help. In this way, amputation and disability can be avoided. Also, you should not treat necrosis with untested folk remedies, so as not to provoke irreversible necrotic processes in the body.

Symptoms and signs related to the circulatory and respiratory systems (R00-R09)

Excluded:

cardiac arrhythmias in the perinatal period (P29.1)
specified arrhythmias (I47-I49)

Excludes: occurring in the perinatal period (P29.8)

Excluded:

gangrene with:
- atherosclerosis (I70.2)
- diabetes mellitus (E10-E14 with a common fourth sign.5)
- other peripheral vascular diseases (I73.-)
gangrene of certain specified localizations - see Alphabetical Index
gas gangrene (A48.0)
pyoderma gangrenous (L88)

In Russia, the International Classification of Diseases, 10th revision (ICD-10) has been adopted as a single normative document for recording morbidity, reasons for the population's visits to medical institutions of all departments, and causes of death.

ICD-10 was introduced into healthcare practice throughout the Russian Federation in 1999 by order of the Russian Ministry of Health dated May 27, 1997. No. 170

The release of a new revision (ICD-11) is planned by WHO in 2017-2018.

With changes and additions from WHO.

Processing and translation of changes © mkb-10.com

Authorization

latest comments

I was looking for GANGRENE OF THE LOWER LIMB WITH DIABETES MELLITUS ICD 10. I FOUND IT! The gas type has a code according to ICD-10 - A48.0, dry or wet - R-02. Gangrene of the lower extremities in diabetes mellitus is E10-E14, and that formed in atherosclerosis is I70.2.

ICD-10. International classification of diseases. . Gangrene, not elsewhere classified. Excluded:

Atherosclerosis (I70.2). diabetes mellitus (E10-E14 with a common fourth sign.5). others.

International classification of diseases ICD-10. . gas gangrene (A48.0) gangrene of certain localizations - see Alphabetical index of gangrene for:

Atherosclerosis (I70.2) diabetes mellitus (E10-E14 with a common fourth.

Gangrene of the lower extremities is necrosis (death) of tissue. . diabetes mellitus, Raynaud's syndrome, vibration disease, etc. gas gangrene - code A48.0 ICD 10. Symptoms.

gas gangrene (A48.0) gangrene of certain localizations - see Alphabetical index of gangrene for:

Atherosclerosis (I70.2) - diabetes mellitus (E10-E14 with a common fourth sign.5) - other peripheral vascular diseases (I73.

Wet gangrene of the lower extremities is tissue necrosis. Gangrene of the lower extremities in diabetes mellitus μBPERCENT!

Diabetic foot according to ICD 10 is a dangerous complication, often. Complications of diabetes. Complications of diabetes mellitus are common. Diabetic foot is a pathological condition of the tissues of the lower extremities.

ICD-10. How does gangrene develop?

ICD-10. . Dry gangrene usually affects the extremities. With it, blockage of blood vessels occurs slowly, over months or even years. . The prognosis worsens in patients with diabetes.

diabetic gangrene of the lower extremities, gangrene of the area. obliterating endarteritis, Raynaud's disease, etc.), infectious diseases, diabetes mellitus. . International Classification of Diseases (ICD-10)

Dry gangrene usually does not progress, being limited to part of the limb segment. . Gangrene in the ICD classification:

R00-R09 Symptoms and signs related to the circulatory and respiratory systems.

R02 - Gangrene, not elsewhere classified. Chain in classification. The diagnosis does not include:

Atherosclerosis (I70.2) diabetes mellitus (E10-E14 with a common fourth sign.5) other diseases.

Definition of obliterating atherosclerosis of the vessels of the lower extremities in ICD 10. Dry gangrene often develops with decompensated diabetes mellitus.

Diabetes mellitus is not only an increase in blood glucose levels, but also a number of undesirable complications that lead to metabolic disorders that develop during the disease.

The first signs of diabetes. Useful video:

how to avoid complications?

Diabetic foot syndrome, ICD 10 code - E10.5, E11.5. . fourth - limited gangrene begins; fifth - extensive gangrene. . Signs of diabetic foot in diabetes mellitus.

Diabetic angiopathy of the lower extremities (ICD-10 code – I79.2*) is one of the most common manifestations of the pathological process. . Gangrene of the lower extremities in diabetes mellitus.

Gangrene of the lower extremities: symptoms and treatment

Gangrene of the lower extremities - main symptoms:

Red spots on the skin
Cardiopalmus
Fever
Vomit
Swelling of the legs
Cramps during sleep
Getting wet
Creepy crawling sensation
Loss of feeling in legs
Reduced physical activity
Leg pain
Coldness of the affected limb
Purulent discharge with an unpleasant odor
Pale skin on the affected leg
Hair loss on legs
Fatigue when walking
Darkening of the skin at the site of the lesion
Trembling legs
Wrinkling of the skin
Dry skin in the affected area

Gangrene of the lower extremities is a dangerous disease, which in the vast majority of cases has an unfavorable prognosis. About every 3rd patient dies from tissue damage and necrosis, and every 2nd becomes disabled.

Pathology is not an independent disease, but always, regardless of the type, is formed against the background of another disease. Causes may include diabetes mellitus, Raynaud's disease, atherosclerosis and other pathological processes.

The symptoms of gangrene are quite specific and pronounced, which forces people to promptly seek qualified help. The main signs include weakness of the limbs, a feeling of “goosebumps” on the skin, pallor of the skin and coldness of the limb.

The correct diagnosis can be made based on data from an objective examination, laboratory tests and instrumental examination. Moreover, diagnosis is simplified due to characteristic symptoms.

Treatment of the disease is always surgical - the scope of the operation can vary from removal of the affected tissue (if it is possible to save the leg) or amputation of the lower limb.

The International Classification of Diseases, Tenth Revision, identifies several codes for gangrene of the legs, differing in the form of its course. The gas type has a code according to ICD-10 - A48.0, dry or wet - R-02. Gangrene of the lower extremities in diabetes mellitus is E10-E14, and that formed in atherosclerosis is I70.2.

Etiology

Despite the fact that such a disease is considered quite rare by clinicians in our time, the causes of gangrene are varied and numerous. The most common triggers are:

extensive injury to connective or cartilage tissue;
deep burns;
prolonged exposure to low temperatures on the feet;
a powerful electric shock or a person being struck by lightning;
the influence of chemical reagents, for example, acidic, alkaline or other aggressive substances;
wounds resulting from a knife or gunshot wound;
the formation of trophic ulcers, which are often a consequence of varicose veins of the legs;
crushing of connective tissue or bones;
bedsores;
vibration disease;
the development of an infectious process against the background of the influence of pathogenic or conditionally pathogenic microflora - this includes streptococci and enterococci, Staphylococcus aureus and Escherichia, as well as clostridia;
the course of atherosclerosis or diabetes mellitus;
Raynaud's disease;
pathologies of the cardiovascular system, in particular heart failure, blood clots, ischemia or embolism;
obliterating endarteritis;
polyneuropathy;
strangulation of a hernia formed in the groin area;
applying a tight bandage, tourniquet or other medical manipulations that lead to severe compression of blood vessels;
a wide range of vascular damage to the lower extremity.

Predisposing factors that increase the risk of necrosis of the skin tissue of the legs are:

sharp fluctuations in body weight - its gain or loss;
a history of anemia;
diseases of the endocrine system;
lack of vitamins in the human body;
failure of the immune system;
the course of chronic pathologies of an infectious nature;
malignant arterial hypertension;
prolonged fasting;
metabolic disorder;
intoxication or dehydration of the body.

Regardless of the influence of one or another cause of gangrene of the lower extremities, in any case, a disruption of the blood circulation process occurs.

Classification

Based on which segment of the leg is affected, the disease is divided into:

gangrene spreading along the entire length of the leg;
gangrene of the foot;
gangrene of the toes;
gangrene of the nail.

Depending on the etiological factor, there are:

ischemic gangrene;
toxic gangrene;
infectious gangrene;
toxic gangrene;
allergic gangrene;
anaerobic gangrene;
hospital gangrene caused by surgery.

Types of gangrene according to clinical course:

dry - formed against the background of a long-term disorder of the circulatory process under aseptic conditions, i.e., without the occurrence of infections. Most often it affects both extremities. It is noteworthy that dry gangrene of the lower extremities very rarely threatens human life - the danger arises only with secondary infection;
gas - there is only one cause - the presence of a deep wound into which pathological microorganisms have penetrated and negatively affected;
wet gangrene is always an unfavorable prognosis. This is due to the fact that the pathological process is always accompanied by infections.

With lesions of the legs, types 1 and 3 of the disease are most common.

Dry gangrene has the following stages of progression:

circulatory disorders;
tissue necrosis;
formation of an inflammatory cushion;
mummification;
development of putrefactive processes;
amputation.

Wet gangrene of the lower extremities as it develops goes through the following stages:

sudden cessation of blood supply;
rapid tissue necrosis, sometimes fulminant;
decomposition or rotting of dead tissue;
penetration of toxins into the blood;
disruption of the functioning of many organs and systems, up to multiple organ failure.

severe itching;
violation of skin integrity;
the appearance of an ischemic zone without inflammation;
attachment of the inflammatory process;
the occurrence of foci of necrosis;
gangrene.

Symptoms

Each of the variants of the course of the disease has its own characteristic clinical manifestations, which the clinician pays attention to during diagnostic measures.

The first signs of incipient dry gangrene are presented:

partial or complete loss of sensitivity of the skin to external irritants;
decreased musculoskeletal activity;
pallor and dry skin at the site of change;
hair loss on the affected leg;
sensation of “goosebumps” on the skin;
convulsions at night;
burning in the affected areas;
pale skin;
rapid fatigue while walking;
the appearance of pain.

If treatment is not carried out when such symptoms occur, then the following will be added to the clinical picture:

final tissue necrosis;
complete loss of sensitivity;
no pulsation;
skin wrinkling;
constant pain;
darkening of the skin on the damaged area;
spontaneous amputation of a limb.

Wet gangrene is characterized by the presence of the following symptoms:

swelling and inflammation of the affected segment;
discharge of dark fluid or pus;
unpleasant odor characteristic of rotting flesh;
increase in temperature in the affected area;
peeling of tissues that are dark green, blue or black;
scarring;
pronounced pain.

Gas gangrene is characterized by the following symptoms:

severe pain syndrome;
pronounced swelling;
the appearance of a weeping wound from which pus or blood is released.

Gangrene of the lower extremities in diabetes mellitus is expressed in:

severe swelling;
decrease in temperature;
marbled shade of the skin in the affected area;
the appearance of red pigment spots;
the formation of bubbles that release a liquid mass interspersed with blood;
pronounced venous network;
inability to feel the pulse and peripheral arterial vessels.

General symptoms of gangrene that accompany any course of the disease:

temperature rise to 41 degrees;
severe chills;
tremor of the lower extremities;
severe weakness, to the point that a person cannot get out of bed;
increased heart rate;
increase in blood tone;
confusion;
bouts of vomiting.

Diagnostics

Gangrene of the lower extremities is suspected based on the presence of characteristic clinical manifestations. Laboratory and instrumental examinations can confirm the diagnosis.

First of all, the clinician must necessarily perform several activities, including:

studying the medical history - to establish the underlying ailment on the basis of which there was a violation of blood circulation in the legs;
collection and analysis of life history;
a thorough examination of the limbs - to determine the extent of the pathological process and assess the condition of the necrosis focus;
a detailed survey of the patient - to determine the first time of manifestation and the severity of clinical signs.

Laboratory research is aimed at:

blood biochemistry;
general clinical blood test;
bacterial culture of secreted fluid during wet gangrene;
microscopy of a piece of skin taken from a diseased area of the leg.

With gangrene of the lower extremities, instrumental diagnosis is limited to radiography, which will show the degree of involvement of the bone in the pathological process. The results will directly affect further treatment with low-traumatic techniques or leg amputation.

Treatment

The only way to treat the disease is surgery. When dry or wet gangrene occurs, amputation of the affected segment is indicated. In addition, the operation can be aimed at:

bypass;
thromboendarterectomy is a procedure for removing atherosclerotic plaques;
balloon distension of the artery;
installation of a stent in an artery;
prosthetics.

taking antibacterial and anti-inflammatory drugs - it is worth noting that antibiotics are used in courses and under the strict supervision of the attending physician;
following a regulated diet that includes a large amount of vitamins and minerals, as well as substances aimed at stimulating the immune system;
carrying out physiotherapeutic procedures - the influence of infrared radiation or other measures is used to remove dead tissue. In addition, the essence of such therapy is to prevent the spread of the necrosis process;
administration of anti-gangrenous serum and crystalloid solutions;
Exercise therapy is often used in the postoperative period, but can also be part of the main treatment.

Therapy with folk remedies is prohibited during such a disease, since it can only aggravate the severity of the problem.

Possible complications

In cases of untreated gangrene of the legs, even if pronounced symptoms appear, patients are at high risk of developing the following consequences:

multiple organ failure;
shock or coma;
sepsis;
loss of limb;
disability.

Prevention and prognosis

Specific measures aimed at preventing the development of gangrene of the lower extremities have not been developed. However, to reduce the likelihood of the disease occurring, you need to adhere to the following rules for the prevention of ischemic gangrene and other types:

avoiding frostbite or extensive burns to the skin of the legs;
timely treatment of pathologies that may be complicated by impaired blood circulation and tissue necrosis;
body weight control;
balanced diet;
avoiding intoxication and dehydration of the body;
use of protective equipment when working with chemicals or aggressive substances;
Regular examination by appropriate specialists - in case of chronic illnesses, for example, diabetes.

Despite the fact that gangrene of the lower extremities is considered a rare disease, it often has a poor prognosis. Amputation of a leg leads to disability of the patient, and complications are fraught with death.

If you think that you have Gangrene of the lower extremities and the symptoms characteristic of this disease, then doctors can help you: a surgeon, a vascular surgeon.

We also suggest using our online disease diagnostic service, which selects probable diseases based on the entered symptoms.

Gangrene

Description of the disease

Gangrene is the death of a part of the body. Any tissue and organs can be affected - skin, subcutaneous tissue, muscles, intestines, gall bladder, lungs, etc. There are dry and wet gangrene.

Dry gangrene often develops when the blood circulation of the limb is impaired in exhausted, dehydrated patients. With the slow development of necrosis, the tissues dry out, wrinkle, mummify, become dense and acquire a dark brown or black color with a bluish tint. Dry gangrene usually does not progress, being limited to part of the limb segment. The onset of clinical manifestations is characterized by the appearance of severe ischemic pain below the site of vessel blockage. The limb becomes pale, then the skin takes on a marbled appearance, becomes cold to the touch, and the pulse cannot be felt. Sensitivity is lost, and a feeling of numbness occurs in the leg. Painful sensations last a long time, which is explained by the preservation of nerve cells among dead tissue and reactive swelling of tissues above the focus of necrosis. Simultaneously with the obstruction of the patency of the main main vessel, a spasm of the collateral arterial branches is usually observed, which accelerates and expands the necrotic process. Starting from the peripheral parts of the extremities, gangrene spreads upward to the level of blockage of the vessel or slightly below. With a favorable course, a demarcation (protective) shaft gradually develops at the border of dead and healthy tissue. Complete tissue rejection and recovery are a long process. Microorganisms in dry tissues develop poorly, however, in the initial phases, putrefactive microflora that gets into them can cause the transition of dry gangrene to wet. In this regard, it is especially important to maintain asepsis before the tissues dry. With dry gangrene, there is almost no decay of dead tissue, and the absorption of toxic products is so insignificant that intoxication is not observed. The general condition of the patient suffers little. This makes it possible, without great risk, to postpone the operation of removing dead tissue (necrectomy) or amputation until the demarcation shaft is completely and clearly visible.

Wet gangrene, putrefactive, is caused by the same reasons as dry gangrene, but more often develops with a rapid circulatory disorder (embolism, vessel injury, etc.) in obese, pasty (edematous) patients. In these cases, the dead tissues do not have time to dry out and undergo putrefactive decay, which leads to abundant absorption of decay products into the body and severe intoxication of the patient. Dead tissue serves as a good breeding ground for microbes, which rapidly develop, leading to the rapid spread of gangrene.

Gangrene in the ICD classification:

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What is diabetic foot: ICD-10 code, classification, causes and treatment methods

One of the most serious complications of diabetes is diabetic foot syndrome.

In a patient who does not adhere to the prescribed diet, who does not closely monitor blood sugar levels, at the stage of decompensation (as a rule, after the diagnosis of the disease), such a complication will certainly manifest itself in one form or another.

Diabetic foot according to ICD 10 is a dangerous complication, often leading to gangrene (tissue necrosis).

Complications of diabetes

Often complications with diabetes occur through the fault of the patient himself. If he is negligent in treatment, neglects medical recommendations, does not monitor his diet, or does not administer insulin in a timely manner, regardless of the type of disease, he will certainly experience complications.

Often the consequences can be severe, and in many cases death cannot be ruled out. Complications can be caused by concomitant illnesses, injuries, incorrect dosage of insulin, or the use of expired (or low-quality) medications.

Some of the most acute complications of diabetes are:

lactic acidosis – a violation of the acidic environment in the body due to the accumulation of large amounts of lactic acids;
ketoacidosis - an increase in the number of ketone bodies in the blood due to insufficient insulin;
hypoglycemic coma is the result of a sharp drop in glucose levels;
hyperosmolar coma - the result of a sharp increase in sugar levels;
diabetic foot syndrome - caused by vascular pathologies in the lower extremities;
retinopathy is a consequence of disorders in the eye vessels;
encephalopathy – damage to brain tissue due to vascular dysfunction;
neuropathy – dysfunction of peripheral nerves due to lack of oxygen saturation of tissues;
Dermal damage is a common manifestation caused by metabolic disorders in skin cells.

What is diabetic foot syndrome?

This type of pathology affects the tissues of the feet. Inflammatory processes in them are accompanied by severe suppuration, which ultimately causes the development of gangrene.

Development of leg ulcers

The causes of such manifestations may be diabetic neuropathy, disorders in the vessels of the lower extremities, aggravated by bacterial infections.

The first International Symposium, held in 1991 and dedicated to diabetic foot syndrome, developed a classification, based on which forms of the disease began to be distinguished according to the predominant provoking factors.

neuropathic form - manifests itself in the form of ulcerations, swelling, destruction of joint tissue, which is a consequence of disturbances in the functioning of the nervous system. These complications are caused by a decrease in the conductivity of nerve impulses in the lower extremities;
ischemic form - is a consequence of atherosclerotic manifestations, against the background of which blood circulation in the lower extremities is impaired;
neuroischemic (or mixed) form - exhibits signs of both types.

Most often, patients with diabetes show signs of the neuropathic form. Next in frequency is the mixed form. The ischemic form of diabetic foot occurs in rare cases. Treatment is based on diagnosis, based on the type (form) of pathology.

Reasons for the development of complications

Diabetes mellitus in the stage of decompensation is characterized by sudden changes in the proportions of sugar in the blood, or by the fact that a high level of its content in the blood remains for a long time. This has a detrimental effect on nerves and blood vessels.

The capillaries of the microcirculatory bed begin to die, and gradually the pathology invades larger and larger vessels.

Improper innervation and blood supply cause insufficient trophism in the tissues. Hence the inflammatory processes accompanied by tissue necrosis. The problem is complicated by the fact that the foot, being one of the most active parts of the body, is constantly exposed to stress and, often, minor injuries.

A person, due to reduced innervation (nerve sensitivity), may not pay attention to minor damage (cracks, cuts, scratches, bruises, abrasions, fungus), which leads to the growth of lesions, since in conditions of insufficient blood circulation in small vessels the protective function of the body does not work in these areas.

As a result, this leads to the fact that small wounds do not heal for a long time, and when infected, they grow into more extensive ulcers, which can be healed without serious consequences only if they were diagnosed at the initial stage.

A syndrome such as diabetic foot is rarely completely eradicated and usually becomes a chronic pathology.

Therefore, the patient is advised to carefully monitor himself, strictly follow the prescribed diet and other medical instructions, and if suspicious manifestations occur, immediately consult a doctor.

Code of atherosclerosis of vessels of the lower extremities according to ICD-10

Atherosclerotic disease complicated by occlusion can cause thromboembolism, trophic ulcers and gangrene. Diagnosis of any of these problems requires knowledge of the coding of conditions specified in ICD 10. Atherosclerosis of the lower extremities in the International Classification of Diseases, 10th revision, is in section I70 - I79.

Usually, the code of a specific disease is well known to doctors specializing in the treatment of vascular pathology. However, doctors of all specialties may encounter problems with the circulatory system presented in ICD 10, so you should have information on specific conditions that arise against the background of vascular diseases. Blockage of arterial trunks anywhere in the body can manifest itself in a variety of symptoms. Knowing the diagnosis code will help you quickly navigate a large number of vascular diseases.

Group of diseases associated with atherosclerotic lesions

All diseases that occur against the background of uncomplicated or complicated atherosclerosis are systematized under the code I70 and include the following pathology options:

atherosclerotic disease of the aorta (I70.0);
damage to the renal arteries (I70.1);
atherosclerosis of the arteries of the lower extremities (I70.2);
narrowing of any other arteries caused by pathological atherogenesis (I70.8);
multiple or unspecified pathological process occurring against the background of atherosclerosis (I70.9).

The doctor can use any code from ICD 10 to indicate a diagnosis of vascular pathology. It is necessary to divide atherosclerosis of the lower extremities into 2 parts - complicated or uncomplicated version. Obliterating vascular atherosclerosis is coded I70.2.

Vascular complications of the legs, systematized in the International Classification

Pathology of the aorta or large main arteries is of great importance for ensuring blood flow in the legs. In particular, if an atherosclerotic plaque has led to disruption of blood flow, then an expansion similar to a saccular aneurysm will form above the narrowing. If atherosclerosis provokes the formation of aneurysmal expansion in the area of the aorta or underlying vessels, then the doctor will set the following code from the 10th revision classification:

aneurysm of the abdominal aorta with or without rupture (I71.3-I71.4);
dilatation of the iliac arteries (I72.3);
aneurysm of the arteries of the lower extremities (I72.4);
aneurysmal dilatation of specified or unspecified localization (I72.8 -I72.9).

In the group of peripheral vascular pathology, the International Classification of the 10th revision identifies the following pathology options:

vascular spasm of small arteries or Raynaud's syndrome (I73.0);
thromboangiitis obliterans, combining inflammation and thrombosis (I73.1);
specified or unspecified peripheral vascular diseases (I73.8-I73.9).

If atherosclerosis in the area of the vessels of the legs causes thrombotic complications, then these types of problems are grouped in the following codes:

thromboembolism of the abdominal aorta (I74.0);
thrombosis of the arteries of the lower extremities (I74.3);
obstruction of the iliac arteries by thrombi or emboli (I74.5).

The obliterating variant of vascular pathology is coded as standard. If severe complications occur (gangrene, trophic ulcers), the ICD 10 code corresponds to the usual code, as does atherosclerosis of the arterial trunks of the femur and leg (I70.2).

Every doctor needs to know and use the International Classification of Diseases codes. In the case of pathology of the blood vessels of the legs, it is important to understand that under one code there can be different options - obliterating or uncomplicated atherosclerosis of the lower extremities. Depending on the preliminary diagnosis, the doctor will use optimal and informative diagnostic methods to confirm the disease variant and choose the best type of therapy. The presence of complications is of great importance: if the doctor sees gangrenous foci, then treatment must be started immediately. However, in all cases, prevention will give the best effect, so you should follow the doctor’s recommendations at the stage of minimal atherosclerotic symptoms, without waiting for skin ulceration or gangrenous lesions of the legs to appear.

The information on the site is provided for informational purposes only and cannot replace the advice of your attending physician.

Wet gangrene of the lower extremities: treatment and life prognosis

Wet gangrene of the lower extremities is necrosis of tissue that does not have time to dry. In the recent past, a diagnosis was a death sentence. With the advent of antibiotics and strong antibacterial drugs, the situation has changed. Death has become rare, and specialists are making efforts to alleviate the patient’s condition.

What is wet gangrene and its symptoms

Tissue necrosis during gangrene occurs in the form of putrefactive decay. There is severe intoxication.

According to the international classification ICD 10, this disease is assigned several codes depending on the location, cause and type of process. Water gangrene of the leg is coded R–02. If the cause of necrosis is diabetes mellitus, then the doctor will indicate codes E10–E14 in the description of the disease.

Classification of the disease by location:

complete necrosis of the limb;
gangrene of the foot;
necrosis of fingers;
necrosis of the nail plates.

Signs accompanying tissue necrosis depend on the type of disease. Symptoms of wet gangrene by location:

the presence of an inflammatory process, edema at the location of the process;
suppuration;
disgusting smell of rotting;
increase in local temperature in the affected area;
detachment of areas of necrosis;
the color of dead tissue is green, black, putrid;
severe pain syndrome.

If the disease is caused by diabetes mellitus, then the manifestations of the disease will be somewhat different. What the doctor will see when examining a patient:

swelling;
marble stains on the skin;
the presence of red spots on the skin;
discharge of fluid with traces of blood;
inability to feel the pulse in peripheral blood vessels.

In addition to local signs of necrosis, there is general damage to the body. The general condition of the patient is as follows:

temperature rise to critical values;
chills, tremor, weakness;
tachycardia;
confusion;
signs of general intoxication;
vomit.

In what cases does it occur?

Wet gangrene of the leg develops as a result of poor circulation in the limb. The causes of this condition are varied:

injuries of large vessels;
tissue crushing;
condition after prolonged compartment syndrome;
damage to blood vessels by bone fragments in closed fractures;
burns – thermal, chemical;
frostbite;
embolus formation;
diabetes;
deep vein thrombosis;
strangulation of a hernia in the lower part of the spinal column;
bedsores;
neuropathy;
Raynaud's disease.

You can live happily ever after with these diseases and not know what gangrene is. These conditions can cause tissue necrosis in the presence of the following factors:

excess body weight;
swelling and posture of tissues;
history of anemia;
diseases of the endocrine system;
immunodeficiency states;
lack of vitamins and nutrients, the use of fasting practices;
the presence of chronic infectious diseases without proper treatment;
intoxication, dehydration;
history of metabolic disorders.

All these processes are accompanied by disruption of normal blood circulation, which provokes the development of gangrene.

What is the life forecast

The wet type of gangrene has a worse prognosis for patient survival. With timely treatment, the disease does not affect life expectancy, but sharply worsens its quality.

Treatment methods

Water gangrene has characteristic external manifestations. The diagnosis is made by a doctor based on the results of an examination of the patient and an analysis of his complaints. All other examination methods are additional and are used to assess the degree of intoxication and identify the pathogenic organism that caused tissue necrosis.

Diagnostics includes:

blood test - there is a decrease in the level of leukocytes and an increase in ROE;
blood biochemistry - an increase in C-reactive protein, a change in normal liver enzymes and urea levels are noted;
urinalysis - allows you to exclude anaerobic gangrene;
x-ray of the limb - also to exclude the anaerobic type of gangrenous process. In addition, to assess the condition of bone structures;
bacterial culture of discharge from a wound - to identify the causative agent of the disease.

Drug therapy includes:

antibiotic therapy with broad-spectrum drugs. The prescription of several types of drugs with different mechanisms of action and active substances is shown;
the use of saline solution, Ringer's solution drip to reduce the severity of intoxication of the body - up to 5 liters per day;
anti-gangrenous serum;
diuretics for enhanced removal of necrosis products;
hemosobtion.

If the disease is detected in the initial stages, limb preservation is possible. Standard tactics include massive antibiotic therapy over long courses, irradiation of the affected area with infrared light, the use of anti-gangrenous serum, and a physical therapy complex.

Possible complications and preventive measures

Gangrene is a life-threatening disease. Even with minor damage to the lower extremities, without emergency treatment, the patient may develop the following complications:

multiple organ failure due to septic damage to the body;
coma;
sepsis;
loss of a limb, fragmentary or complete;
disability;
death.

No specialized procedures have been developed for the prevention of limb tissue necrosis. To reduce the likelihood of developing the disease, doctors recommend:

monitor your weight and diet;
timely and fully treat any infectious and chronic diseases;
exclude frostbite and thermal effects on the skin of the extremities;
compliance with safety regulations when working with chemicals and equipment;
For patients with diabetes, follow the recommendations of the endocrinologist and monitor the condition of the skin of the feet.

Main symptoms:

Pale skin on the affected leg
Leg pain
Fatigue when walking
Hair loss on legs
Purulent discharge with an unpleasant odor
Trembling legs
Getting wet
Creepy crawling sensation
Darkening of the skin at the site of the lesion
Loss of feeling in legs
Coldness of the affected limb
Wrinkling of the skin
Reduced physical activity
Dry skin in the affected area

Pathology is not an independent disease, but always, regardless of the type, is formed against the background of another disease. Other pathological processes can also serve as causes.

The correct diagnosis can be made based on data from an objective examination, laboratory tests and instrumental examination. Moreover, diagnosis is simplified due to characteristic symptoms.

Treatment of the disease is always surgical - the scope of the operation can vary from removal of the affected tissue (if it is possible to save the leg) or amputation of the lower limb.

Etiology

Despite the fact that such a disease is considered quite rare by clinicians in our time, the causes of gangrene are varied and numerous. The most common triggers are:

extensive injury to connective or cartilage tissue;
deep burns;
prolonged exposure to low temperatures on the feet;
a powerful electric shock or a person being struck by lightning;
the influence of chemical reagents, for example, acidic, alkaline or other aggressive substances;
wounds resulting from a knife or gunshot wound;
formation, which are often a consequence of legs;
crushing of connective tissue or bones;
vibration disease;
the development of an infectious process against the background of the influence of pathogenic or conditionally pathogenic microflora - this includes Escherichia, as well as clostridia;
the course of atherosclerosis or diabetes mellitus;
Raynaud's disease;
pathologies of the cardiovascular system, in particular the formation of blood clots, or;
strangulation of a hernia formed in the groin area;
applying a tight bandage, tourniquet or other medical manipulations that lead to severe compression of blood vessels;
a wide range of vascular damage to the lower extremity.

Predisposing factors that increase the risk of necrosis of the skin tissue of the legs are:

sharp fluctuations in body weight - its gain or loss;
presence in medical history;
diseases of the endocrine system;
lack of vitamins in the human body;
failure of the immune system;
the course of chronic pathologies of an infectious nature;
malignant;
prolonged fasting;
metabolic disorder;
or organism.

Regardless of the influence of one or another cause of gangrene of the lower extremities, in any case, a disruption of the blood circulation process occurs.

Classification

Based on which segment of the leg is affected, the disease is divided into:

gangrene spreading along the entire length of the leg;
gangrene of the foot;
gangrene of the toes;
gangrene of the nail.

Depending on the etiological factor, there are:

ischemic gangrene;
toxic gangrene;
infectious gangrene;
toxic gangrene;
allergic gangrene;
anaerobic gangrene;
hospital gangrene caused by surgery.

Types of gangrene according to clinical course:

- is formed against the background of a long-term disorder of the circulatory process under aseptic conditions, i.e., without the occurrence of infections. Most often it affects both extremities. It is noteworthy that dry gangrene of the lower extremities very rarely threatens human life - the danger arises only with secondary infection;
- there is only one cause - the presence of a deep wound into which pathological microorganisms have penetrated and negatively affected;
wet gangrene is always an unfavorable prognosis. This is due to the fact that the pathological process is always accompanied by infections.

With lesions of the legs, types 1 and 3 of the disease are most common.

Dry gangrene has the following stages of progression:

circulatory disorders;
tissue necrosis;
formation of an inflammatory cushion;
mummification;
development of putrefactive processes;
amputation.

Wet gangrene of the lower extremities as it develops goes through the following stages:

sudden cessation of blood supply;
rapid tissue necrosis, sometimes fulminant;
decomposition or rotting of dead tissue;
penetration of toxins into the blood;
disruption of the functioning of many organs and systems, up to.

severe itching;
violation of skin integrity;
the appearance of an ischemic zone without inflammation;
attachment of the inflammatory process;
the occurrence of foci of necrosis;

Symptoms

Each of the variants of the course of the disease has its own characteristic clinical manifestations, which the clinician pays attention to during diagnostic measures.

The first signs of incipient dry gangrene are presented:

partial or complete loss of sensitivity of the skin to external irritants;
decreased musculoskeletal activity;
pallor and dry skin at the site of change;
hair loss on the affected leg;
sensation of “goosebumps” on the skin;
convulsions at night;
burning in the affected areas;
pale skin;
rapid fatigue while walking;
the appearance of pain.

If treatment is not carried out when such symptoms occur, then the following will be added to the clinical picture:

final tissue necrosis;
complete loss of sensitivity;
no pulsation;
skin wrinkling;
constant pain;
darkening of the skin on the damaged area;
spontaneous amputation of a limb.

Wet gangrene is characterized by the presence of the following symptoms:

swelling and inflammation of the affected segment;
discharge of dark fluid or pus;
unpleasant odor characteristic of rotting flesh;
increase in temperature in the affected area;
peeling of tissues that are dark green, blue or black;
scarring;
pronounced pain.

Gas gangrene is characterized by the following symptoms:

severe pain syndrome;
pronounced swelling;
the appearance of a weeping wound from which pus or blood is released.

Gangrene of the lower extremities in diabetes mellitus is expressed in:

severe swelling;
decrease in temperature;
marbled shade of the skin in the affected area;
the appearance of red pigment spots;
the formation of bubbles that release a liquid mass interspersed with blood;
pronounced venous network;
inability to feel the pulse and peripheral arterial vessels.

General symptoms of gangrene that accompany any course of the disease:

temperature rise to 41 degrees;
severe chills;
tremor of the lower extremities;
severe weakness, to the point that a person cannot get out of bed;
increased heart rate;
increase in blood tone;
confusion;
bouts of vomiting.

Diagnostics

Gangrene of the lower extremities is suspected based on the presence of characteristic clinical manifestations. Laboratory and instrumental examinations can confirm the diagnosis.

First of all, the clinician must necessarily perform several activities, including:

studying the medical history - to establish the underlying ailment on the basis of which there was a violation of blood circulation in the legs;
collection and analysis of life history;
a thorough examination of the limbs - to determine the extent of the pathological process and assess the condition of the necrosis focus;
a detailed survey of the patient - to determine the first time of manifestation and the severity of clinical signs.

Laboratory research is aimed at:

blood biochemistry;
general clinical blood test;
bacterial culture of secreted fluid during wet gangrene;
microscopy of a piece of skin taken from a diseased area of the leg.

Treatment

The only way to treat the disease is surgery. When dry or wet gangrene occurs, amputation of the affected segment is indicated. In addition, the operation can be aimed at:

bypass;
thromboendarterectomy is a procedure for removing atherosclerotic plaques;
balloon distension of the artery;
installation of a stent in an artery;
prosthetics.

taking antibacterial and anti-inflammatory drugs - it is worth noting that antibiotics are used in courses and under the strict supervision of the attending physician;
following a regulated diet that includes a large amount of vitamins and minerals, as well as substances aimed at stimulating the immune system;
carrying out physiotherapeutic procedures - the influence of infrared radiation or other measures is used to remove dead tissue. In addition, the essence of such therapy is to prevent the spread of the necrosis process;
administration of anti-gangrenous serum and crystalloid solutions;
Exercise therapy is often used in the postoperative period, but can also be part of the main treatment.

Therapy with folk remedies is prohibited during such a disease, since it can only aggravate the severity of the problem.

Possible complications

In cases of untreated gangrene of the legs, even if pronounced symptoms appear, patients are at high risk of developing the following consequences:

multiple organ failure;
shock or coma;
loss of limb;
disability.

Gangrene of the left foot, ICD code 10. Types, signs and treatment of gangrene of the lower extremities

Types of gangrene of the feet

Features of ICD-10 coding

Gangrene of the foot

Gangrene of the toes

Gangrene of other parts of the lower extremities

Diabetic gangrene

Causes of gangrene development

Types of gangrene depending on the cause of development

ICD-10

How does gangrene develop? (pathogenesis)

Symptoms and signs, photos

First signs. How does gangrene begin?

Symptoms of dry gangrene of the extremities

Symptoms of wet gangrene of the extremities

Features of pain with gangrene

Temperature and intoxication

Features of the course of some forms of gangrene

Anaerobic gas gangrene

Fournier's gangrene

Intestinal gangrene

Gangrenous cholecystitis

Gangrenous appendicitis

Abscess and gangrene of the lung

Diagnostics

Laboratory research methods for gangrene

Instrumental research methods for gangrene

Complications and consequences of gangrene

Treatment

Treatment of dry gangrene

Treatment of wet gangrene

Treatment of gas gangrene

Treatment of gangrene of the lung, intestines, gangrenous cholecystitis and appendicitis

Use of antibiotics

Use of painkillers

Ointments for gangrene

Surgical operations for gangrene, main types

Is it possible to cure limb gangrene without amputation?

How to cure gangrene at home? Traditional methods of treatment

Gangrene of the leg (diabetic foot): surgical treatment without amputation - video

Forecast

How long do people live with gangrene?

Prevention of gangrene

Answers to frequently asked questions

Gangrene in diabetes mellitus. What are the features of sugar gangrene?

Is gangrene contagious and what are the modes of transmission?

Does gangrene occur in children?

Coding of foot gangrene according to ICD 10

Encoding Features

Prevention Approaches

Types, signs and treatment of gangrene of the lower extremities

Why does cell death occur?

Types of gangrene

Symptoms

Preventive and therapeutic effects

Symptoms and signs related to the circulatory and respiratory systems (R00-R09)

Authorization

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Gangrene of the lower extremities: symptoms and treatment

Gangrene of the lower extremities - main symptoms:

Etiology

Classification

Symptoms

Diagnostics

Treatment

Possible complications

Prevention and prognosis

Gangrene

Description of the disease

Gangrene in the ICD classification:

What is diabetic foot: ICD-10 code, classification, causes and treatment methods

Complications of diabetes

What is diabetic foot syndrome?

Reasons for the development of complications

Code of atherosclerosis of vessels of the lower extremities according to ICD-10

Group of diseases associated with atherosclerotic lesions

Vascular complications of the legs, systematized in the International Classification

Wet gangrene of the lower extremities: treatment and life prognosis

What is wet gangrene and its symptoms

In what cases does it occur?