About gangrene

What is gangrene?

Gangrene facts

  • Gangrene refers to dead or dying body tissue(s) that occur because of inadequate blood supply.
  • There are two major types of gangrene, wet gangrene and dry gangrene.
  • Dry gangrene can result from conditions that reduce or block arterial blood flow such as diabetes, arteriosclerosis, and tobacco addiction as well as from trauma, frostbite, or injury.
  • Wet gangrene can result from the same causes as dry gangrene but always includes infection. In some cases of wet gangrene, the initial cause is considered to be the infection.
  • Treatment for all cases of gangrene usually involves surgery, medical treatment, supportive care, and occasionally, rehabilitation.

What is gangrene?

Gangrene is a term that describes dead or dying body tissue(s) that occur because the local blood supply to the tissue is either lost or is inadequate to keep the tissue alive. Gangrene has been recognized as a localized area of tissue death since ancient times. The Greeks used the term gangraina to describe putrefaction (death) of tissue. Although many laypeople associate the term gangrene with a bacterial infection, the medical use of the term includes any cause that compromises the blood supply that results in tissue death. Consequently, a person can be diagnosed with gangrene but does not have to be "infected."

There are two major types of gangrene, referred to as dry and wet. Many cases of dry gangrene are not infected. All cases of wet gangrene are considered to be infected, almost always by bacteria. The most common sites for both wet and dry gangrene to occur are the digits (fingers and toes) and other extremities (hands, arms, feet, and legs).

What is the difference between wet and dry gangrene?

Wet (also sometimes termed "moist") gangrene is the most dangerous type of gangrene because if it is left untreated, the patient usually develops sepsis and dies within a few hours or days. Wet gangrene results from an untreated (or inadequately treated) infection in the body where the local blood supply has been reduced or stopped by tissue swelling, gas production in tissue, bacterial toxins, or all of these factors in combination. Additionally, conditions that compromise the blood flow such as burns or vascular trauma (for example, a knife wound that cuts off arterial flow) can occur first. Then the locally compromised area becomes infected, which can result in wet gangrene. Wet gangrene is the type that is most commonly thought of when the term gangrene is used. Wet gangrene often produces an oozing fluid or pus, hence the term "wet." Early stages of wet gangrene may include signs of infection, aching pain with swelling, a reddish skin color or blanched appearance if the area is raised above level of the heart, coolness on the skin surface, ulceration, and a crackly sensation when the skin is pressed due to gas in the tissue. These stages may progress rapidly over hours to days.

Dry gangrene, if it does not become infected and progress to wet gangrene, usually does not cause sepsis or cause the patient to die. However, it can result in local tissue death with the tissue eventually being sloughed off. Usually, the progression of dry gangrene is much slower (days to months) than wet gangrene because the vascular compromise slowly develops due to the progression of diseases that can result in local arterial blockage over time. The stages are similar to wet gangrene (see above), except there is no infection, pus, wetness, or crackly-feeling skin because there is no gas production in the uninfected tissue. There are many diseases that may lead to dry gangrene; the most common are diabetes, arteriosclerosis, and tobacco addiction (smoking). Infrequently, dry gangrene can occur quickly, over a few hours to days, when a rapid arterial blockage occurs (for example, an arterial blood clot suddenly occludes a small artery to a toe). Dry gangrene often produces cool, dry, and discolored appendages (sometimes termed "mummified") with no oozing fluid or pus, hence the term "dry."



What are the symptoms for gangrene?

Glossy symptom was found in the gangrene condition

When gangrene affects your skin, signs and symptoms may include:

  • Skin discoloration — ranging from pale to blue, purple, , 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

If you have a type of gangrene that affects tissues beneath the surface of your skin, such as gas gangrene or internal gangrene, you may notice that:

  • The affected tissue is swollen and very painful
  • You're running a low-grade Fever and generally feel unwell

A condition called septic shock can occur if a Bacterial infection that originated in the gangrenous tissue spreads throughout your body. Signs and symptoms of septic shock include:

  • Low blood pressure
  • Fever, possibly, though temperature may also run lower than the normal 96.8 F (36 C)
  • Rapid heart rate
  • Lightheadedness
  • Shortness of breath
  • Confusion

When to see a doctor

Gangrene is a serious condition and needs immediate treatment. Call your doctor right away if you have persistent, unexplained Pain in any area of your body along with one or more of the following signs and symptoms:

  • Persistent fever
  • Skin changes — including discoloration, warmth, swelling, Blisters or Lesions — that won't go away
  • A foul-smelling discharge leaking from a sore
  • Sudden Pain at the site of a recent surgery or trauma
  • Skin that's pale, hard, cold and numb



What are the causes for gangrene?

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 . 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.



What are the treatments for gangrene?

Treatment of gangrene depends upon the type of gangrene (dry vs. wet), the subtype of wet gangrene, and upon how much tissue is compromised by the gangrene. Immediate treatment is needed in all cases of wet gangrene and in some cases of dry gangrene. Treatment for all cases of gangrene usually involves surgery, medical treatment, supportive care, and occasionally, rehabilitation.

Dry gangrene is usually treated with surgery that removes the dead tissue(s), such as a toe. How much tissue is removed may depend on how much arterial blood flow is still reaching other tissue(s). Often, the patient is treated with antibiotics to prevent infection of remaining viable tissue. The patient may also receive anticoagulants to reduce blood clotting. Supportive care can consist of surgical wound care and rehabilitation for reuse of the digits or limb. Some patients simply slough off the dry gangrenous tissue (termed autoamputation). This happens most often when medical and surgical caregivers are not readily available to the patient in remote areas or in some third world countries. Many patients, if they do not get infected, can recover from autoamputation.

Wet gangrene is a medical emergency and needs immediate treatment. Treatment is usually done in a hospital, and a surgeon needs to be involved because the local area needs debridement (surgical removal of the dead and dying tissue). In some patients, debridement will not be adequate therapy, and amputation of a limb may be needed. At the same time as surgical treatment, intravenous antibiotics (usually a combination of two or more antibiotics, one of which is effective in killing anaerobic bacteria like Clostridium perfringens and another antibiotic effective against methicillin-resistant Staphylococcus aureus or mrsa) need to be administered. Consultation with an infectious disease specialist and a surgeon is recommended. Internal gangrene requires an operation in the hospital to remove the gangrenous tissue. Some patients develop sepsis and require the support of an intensive-care unit in which supportive care for other life-threatening problems such as hypotension (low blood pressure) can be treated. Rehabilitation therapy for patients with amputation is highly recommended.

Some clinicians treat gangrene, especially wet gangrene, with hyperbaric oxygen (oxygen given under pressure with the patient inside a chamber). Since some studies indicate that hyperbaric oxygen treatment improves tissue oxygen supply and can inhibit or kill anaerobic bacteria, this therapy is used to treat patients with gangrene. However, it is not available in many hospitals and is used in conjunction with the above described therapeutic methods, not as a primary therapy for wet gangrene.



What are the risk factors for gangrene?

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.



Is there a cure/medications for gangrene?

Damaged tissue from gangrene cannot be saved. However, medication is available to help avoid gangrene from worsening. The sooner you receive therapy, the greater your chances of recovery.

Gangrene treatment may comprise one or more of the following:

  • Medication: Antibiotics are administered intravenously or orally to treat bacterial infections. To alleviate discomfort, pain medicines may be administered.
  • Surgery: Depending on the kind of gangrene and its degree, many surgeries may be required. Gangrene surgery involves the following procedures:
    i. Debridement. This operation is performed to remove contaminated tissue and prevent the infection from spreading.
    ii. Vascular surgery is performed. To restore blood flow to the affected area, surgery may be performed to restore any damaged or diseased blood vessels.
    iii. Amputation. In extreme situations of gangrene, the afflicted body part may have to be surgically removed, such as a toe, finger, arm, or leg (amputated). You may be implanted with an artificial limb in the future (prosthesis).
  • Hyperbaric oxygen therapy is performed in a chamber filled with pure oxygen. Typically, you will be lying on a padded surface that glides into a transparent plastic tube. The pressure within the chamber will gradually grow to approximately 2.5 times normal air pressure.
    • The supply of oxygen transported by the blood rises with hyperbaric oxygen therapy. Bacteria that thrive in tissue that lacks oxygen are slowed by oxygen-rich blood. It also aids in the healing of infected wounds.
    • A 90-minute hyperbaric oxygen therapy session for gangrene is typical. Two to three treatments per day may be required until the illness is eradicated.
Symptoms
Skin colour changes ranging from mild grey to blue, purple, , bronze, or red,Swelling,Blisters,Sudden, acute pain is followed by numbness,A foul-smelling discharge from a wound,Skin that is thin, glossy, or hairless,Skin that is cool to the touch or cold to the touch
Conditions
Fever that persists,Skin changes that persist, such as pigmentation, warmth, edoema, blisters, or lesions,A foul-smelling discharge from a wound,Pain that appears suddenly at the location of recent surgery or accident,Pale, hard, chilly, and numb skin
Drugs
Gram-positive (penicillin or cephalosporin),Gram-negative (aminoglycoside, third-generation cephalosporin, or ciprofloxacin),Anaerobic coverage (clindamycin or metronidazole)



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