Modern surgery, general and operative . r,and, if pain is severe, give morphinhypodermatically. Amyl nitrite iswithout value in this attacks of Raynauds diseaseare so severe as to threaten gan-grene, put the patient to bed; if the feet are attacked, elevate the legsslightly, wrap the affected extremities in cotton-wool, and apply the hands are affected, wrap them in cotton-wool, elevate them slightly,and apply warmth. Massage is useful. Arteriovenous anastomosis has beenemployed for threatened gangrene, and several apparent successes have beenreported (see page 179). W
Modern surgery, general and operative . r,and, if pain is severe, give morphinhypodermatically. Amyl nitrite iswithout value in this attacks of Raynauds diseaseare so severe as to threaten gan-grene, put the patient to bed; if the feet are attacked, elevate the legsslightly, wrap the affected extremities in cotton-wool, and apply the hands are affected, wrap them in cotton-wool, elevate them slightly,and apply warmth. Massage is useful. Arteriovenous anastomosis has beenemployed for threatened gangrene, and several apparent successes have beenreported (see page 179). When gangrene occurs, dress the part antisepticallyuntil a line of demarcation forms, and then remove the dead parts by scissors,forceps, and antiseptic fomentations. If amputation becomes necessary, waitfor a line of demarcation. In gangrene of a toe, toes, or foot due to angio-thrombosis or obliterative endarteritis, amputation is always necessary. Theterrible pain calls for it, and even if the gangrenous area is very small it is cer-. FiG. 94.—Raynauds gangrene. Patient haslost most of the terminal phalanges of the fingersand also the left leg. Right leg was ampu-tated soon after this picture was taken. (Patientof Dr. T. E. Wannamaker, Jr., of Cheraw, S. C.) Diabetic Gangrene and Diabetic Coma igi tain to spread or new areas are sure to arise. This form of gangrene has beentreated by several surgeons by anastomosing the femoral vein to the femoralartery. Several times this operation seems to have proved successful. In anadvanced case with thrombosed veins it cannot succeed (see page 179). Diabetic gangrene often resembles strongly senile gangrene, but in manycases the dead portions remain somewhat moist and putrefy. Some surgeonsattribute it directly to the sugar in the blood. Some think diabetes causesgangrene indirectly by rendering the tissues less resistant to infection and lesscapable than normally of repair. We know that sugar in blood removes fluidfrom the tissues an
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