Management of Gangrene
Management and treatment of gangrene wounds requires an aggressive protocol of:
- Wound care
Whenever there is suspicion of gangrene (necrosis of tissue), aggressive surgical exploration is needed to confirm the diagnosis.
This procedure also allows an initial therapy, due to its debridement of necrotic tissue. A “second-look” surgery should be done a day later. Eventually, there may be necessary 3-4 debridement procedures, which is the average.
Antibiotics should begin as early as possible, even before any cultures identify the infectious organism(s) or before the sensitivities to antibiotics associated with those organisms are determined. Pending these cultures and their sensitivity results, there should be antibiotic coverage for gram-negative and gram-positive organisms and both aerobic and anaerobic bacteria, as well as antibiotics that treat resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA). Once the cultures are completed and sensitivities assessed, these results can fine-tune the antibiotic therapy.
A gangrenous wound should not be closed until all necrotic areas are clear (absent) and the tissue is well-vascularized. In the interval, covering should be done to protect the open wound from exposure to more pathogens and to keep it moist.