An elderly person with occlusive arterial disease presents with shriveled skin over the affected part. This part is brown or black in colour and gives a foul smelling odour. The condition is DRY GANGRENE.

Dry gangrene develops because of gradual deprivation of arterial blood supply. Although there is  arterial occulusion the venous supply remains unimpeded. There is a definite bright red line of demarcation that appears between the living and the dead tissue. This dry gangrene is mostly seen in senile diabetics, buerger’s disease, raynaud’s disease, embolism, ligation, injury to a vessel, frostbite, oracid or alkali burns.

SYMPTOMS

When gangrene affects skin, signs and symptoms may include:

• Skin discoloration — ranging from pale to blue, purple, black, bronze or red, depending on the type of gangrene you have
• Swelling or the formation of blisters filled with fluid on the skin
• A clear line between healthy and damaged skin
• Sudden, severe pain followed by a feeling of numbness
• A foul-smelling discharge leaking from a sore
• Thin, shiny skin, or skin without hair
• Skin that feels cool or cold to the touch
• Low blood pressure
• Fever, possibly, though temperature may also run lower than the normal 98.6 F (37 C)
• Rapid heart rate
• Lightheadedness
• Shortness of breath
• Confusion

GANGRENE MAY OCCUR DUE TO ONE OR SOME OF THE FOLLOWING CAUSES

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

TYPES OF GANGRENE

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

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

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

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

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

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

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

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

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

RISK FACTORS

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

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

Complications

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

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

Prevention

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

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

Homoeopathic Treatment:

The patient should receive general treatment such as a nutrition diet, control of blood sugar, relief from pain and care of the heart.

            The affected part should be kept dry. Keep the part elevated to reduce pain. Do not apply any hot fomentation or warmth over the affected area, protect the part from local pressure. Keep the wound clean by removing the slough and paring the nails.

Secale cornutum is ergot of rye, a fungus. It contracts the muscles of the blood is very thin, foetid, watery and black, oozing continuosly. The skin gets shriveled, numb, mottled and dusky with a blue tinge. Dry gangrene develops slowly, with bloody blisters. The varicose ulcers are foul and indolent with a burning sensation that is better by cold. Patient wants parts uncovered, although the skin is cold to touch. Pains are neuralgic and sharp, burning like fire. Great restlessness, great debility and prostration to the point of collapse.

Anthracinum is anthrax nosode and is very valueable in the treatment of malignant disease or septic inflammations of connective or cellular tissues. It produces boils, malignant ulcers, abscesses and buboes, where there is a purulent focus. Great restlessness with debility, depression and pain in limbs. General sense of malaise and terrible burning pains.

Arsenicum album is a deep acting remedy affecting every organ and tissue. It produces inveterate neuralgias and multiple neuritis. Great anxiety, exhaustion and restlessness, with nocturnal aggravation; better by heart. The skin is dry, shriveled, like parchment. Eruptions are dry, rough, scaly and worse cold.

Phosphorus is a remedy of haemorrhagic diathesis as blood looses its coagulability. The pains, in general are burning in character and the patient has marked thirst for cold water. The ulcers bleed easily on slightest touch. The large ulcers are surrounded by smaller ones. Burning of skin with restlessness.

Lachesis mutus has a bluish-purple appearance of boils and ulcers; dark blister with black edges. Small wounds bleed easily. Capillaries are dilated.

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