Phalanx gangrene: what to do

Dear Sirs,

I kindly ask you a further consultation with you as regards the diagnosis I was made today December 6: “Traces of gangrene limited to the nail phalanx and of finger inflammation. Moreover, chronic renal failure deriving from a stroke with left hemisoma insufficiency”.

Thank you for your attention,

Serena

One comment on “Phalanx gangrene: what to do

  1. Sofia Fioravanti on

    Dear Serena,
    Thank you for writing us. I’m really sorry for the condition you and your relative are experiencing.

    In your request, you speak about circumscribed gangrene that is a condition that it is created because in a specific part of the body the oxygen fails for whatsoever reason. In this case, this problem is supported by concomitant diseases such as stroke and chronic renal failure.

    Indeed, if of ischemic origin, stroke causes diffuse arteriopathy; renal failure, on the contrary, is linked to a lack of blood flow as it triggers the release of toxic substances coming from the ischemic tissue.

    The first thing to do is to check and correct atherosclerosis risk factors such as smoke, cholesterol and high triglycerides, diabetes, arterial hypertension, obesity and inactivity. Therefore, it is necessary to carry out nutritional education and rehabilitation to reduce stroke outcomes as much as possible as well as to perform physical activity. It is also fundamental to protect the limb from cold, which causes a further vasoconstriction.

    It is also essential if you haven’t already done it, to undergo a visit at a vascular surgeon to exclude problems in other zones and possible solutions (e.g. revascularization).

    At this point, you can undergo a visit with a team of experts. At our Centre, for example, you undergo a first visit with doctor and nurses where you evaluate the patients’ general state of health (diseases and drugs he takes), the wound’s conditions, (its size, if it is granulating -it is “red”- or it is necrotic – it is “black”), how much oxygen reaches the wound area and the circulation status. Eventually, pain is evaluated, a very common part of this kind of problem.

    On the basis of these data, a customized therapeutic pathway is created.
    It can include:
    1. HBOT that is hyperbaric oxygen therapy. In these cases it is very useful because firstly it promotes neoangiogenesis (new vessels are created, defined collateral circles. They bring blood to the area “bypassing” a potential obstruction) and secondly because it enhances the production of nitric oxide, a powerful vasodilator and natural antibiotic that helps to fight the inflammation you talk about, that is none other than an inflammation condition. By carrying oxygen to the painful tissue, necrosis is demarcated and those cells intended for apoptosis, that is programmed death, get saved. It is important to highlight that IT DOESN’T reactivate death cells.
    HBOT therapy lasts 90 minutes. You are always with other patients and there is always a nurse or a doctor inside the chamber.

    2. Medications, whose aim is to “dry” the part affected by gangrene in order to localize it and favour its natural detachment. They are always made with Povidone-iodine and Iodoform gauze.

    3. FREMS, a therapy that employs biocompatible electrical signals useful, in your case, to stimulate microcirculation. It can also have a beneficial effect in case of pain. The specific treatment program and the number of sessions are decided by the doctor. You are normally prescribed packages of 15 sessions to be performed daily through small transcutaneous electrodes in the area to be treated. The patient lies down on the bed and once the electrodes have been applied, the nearly 30-minutes treatment starts.

    The whole Centre is at your disposal. In case of doubt, questions or to book a visit, I would recommend you to contact our secretariat at the number +39 0544 500152 or by email at the address segreteria@iperbaricoravenna.it

    Thank you for the trust you have placed in us,
    Best regards,
    Sofia Fioravanti
    Nurse of the Ravenna Wound Care Centre

    Reply

Leave a Reply

Your email address will not be published. Required fields are marked *