Gangrene

Definition
Gangrene refers to the decay and death of tissue resulting from an interruption in
blood flow to a certain area of your body. Some types of gangrene also involve a
bacterial infection. Gangrene most commonly affects the extremities, including your
toes, fingers and limbs, but can also occur in your muscles and internal organs.

Your chances of developing gangrene are higher if you have an underlying condition
that can damage your blood vessels and impede blood flow, such as diabetes or
atherosclerosis.

Treatments for gangrene include surgery to remove dead tissue, antibiotics and other
approaches. The prognosis for recovery is good if gangrene is identified early and
treated quickly.

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

 A blue or black discoloration of your skin

 Severe pain followed by a feeling of numbness
 A foul-smelling discharge

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 painful

 You're running a fever and 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

 Rapid heart rate
 Lightheadedness
 Shortness of breath
 Confusion

Causes
Gangrene occurs when a body part — your skin, muscle or even an organ — loses its
blood supply. The blood that feeds your tissues provides oxygen, nutrients to feed
your cells and immune system components, such as antibodies, to ward off infections.
Without a proper blood supply, your cells can't survive.

Any process that affects blood flow — an injury or an underlying condition or

especially, a combination of the two — can lead to gangrene. The types of gangrene
include:

 Dry gangrene. Dry gangrene is characterized by dry and shriveled skin ranging in color
from brown to purplish-blue to black. Usually, dry gangrene develops slowly. It occurs most
commonly in people who have a blood vessel disease, such as atherosclerosis.
 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 can develop following 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 grey 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 usually caused by an infection by the bacteria 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 become life-threatening.

 Internal gangrene. Gangrene affecting one or more of your organs, most commonly your
intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene
occurs when blood flow to an internal organ is blocked. This can occur when your
intestines bulge through a weakened area of muscle in your abdomen (hernia) and become
twisted. Internal gangrene often causes a fever and severe pain. Left untreated, internal
gangrene can be fatal.
 Fournier's gangrene. Fournier's gangrene is an uncommon type of gangrene that involves
the genital organs. Men are most 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.
Risk factors
Several factors increase your risk of developing gangrene. These include:

 Age. Gangrene occurs far more often in older people.

 Diabetes. If you have diabetes, your body doesn't produce sufficient amounts
of the hormone insulin (which helps your cells take up glucose) or is resistant
to the effects of insulin. Diabetes along with its high blood sugar levels can
eventually damage blood vessels, 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
impedes blood flow to the injured area.
 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.

When to seek medical advice

Gangrene is a serious condition and needs immediate treatment. Call your doctor right
away if you notice any of the following signs and symptoms:

 Persistent, unexplained pain in an area of your body

 Persistent fever
 A wound that's slow to heal or recurring sores
 A foul-smelling discharge leaking from a sore
 Skin that's become pale, hard, cold and numb — which may be an indication
of frostbite

Tests and diagnosis

Your doctor will likely ask you whether you've recently experienced any trauma, such
as an injury or surgery, to the affected area of your body. You'll also talk about your
medical history, including any chronic conditions, such as diabetes, which could lead
to damaged blood vessels. Tests used to help make a diagnosis of gangrene include:

 Blood tests. An abnormally elevated white blood cell count often indicates the
presence of an infection.
 Imaging tests. An X-ray, a computerized tomography (CT) scan or a
magnetic resonance imaging (MRI) scan can be used to view interior body
structures and assess the extent to which gangrene has spread.

An arteriogram is an imaging test used to visualize your arteries. During this

test, dye is injected into your bloodstream and X-ray pictures are taken to
 determine how well blood is flowing through your arteries. An arteriogram
can help your doctor find out whether any of your arteries are blocked.

 Surgery. Surgery may be performed to determine the extent to which

gangrene has spread within your body.
 Fluid or tissue culture. A culture of the fluid from a blister on your skin may
be examined for the bacteria Clostridium perfringens, a common cause of gas
gangrene, or your doctor may look at a tissue sample under a microscope for
signs of cell death.

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.

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

Treatments and drugs

Tissue that has been damaged by gangrene can't be saved, but steps can be taken to
prevent gangrene from progressing. These treatments include:

 Surgery. Your doctor will remove the dead tissue, which helps stop gangrene
from spreading and allows healthy tissue to heal. If possible, your doctor may
repair damaged or diseased blood vessels in order to increase blood flow to the
affected area.

A skin graft is a type of reconstructive surgery that may be used to treat

gangrene that's caused extensive damage to your skin. During a skin graft,
your doctor removes healthy skin from another part of your body — usually a
place hidden by clothing — and carefully spreads it over an affected area. The
healthy skin may be held in place by a dressing or by a couple of small
stitches. A skin graft can only be done if an adequate blood supply has been
restored to the damaged skin.

In severe cases of gangrene, an affected body part, such as a toe, finger or

limb, may need to be surgically removed (amputated). In some cases, you may
be fitted with an artificial limb (prosthesis).

 Antibiotics. Antibiotics given through a vein (intravenous) may be used to

treat gangrene that's become infected.
 Hyperbaric oxygen therapy. In this type of therapy, you'll be situated in a
special chamber, which usually consists of a padded table that slides into a
clear plastic tube. The chamber is pressurized with pure oxygen, and the
pressure inside the chamber will slowly rise to about two and a half times
normal atmospheric pressure.
 Hyperbaric oxygen therapy may be used to treat gas gangrene. Under
increased pressure and increased oxygen content, your blood is able to carry
greater amounts of oxygen. Blood rich in oxygen inhibits the growth of
bacteria that thrive in the absence of oxygen and helps infected wounds heal
more easily.

Hyperbaric oxygen therapy may last anywhere from 30 minutes to two hours,
and you may require more than one session. During the therapy, your ears
might pop as they adjust to the increased pressure. Afterward, you may feel
lightheaded and tired.

Other treatments for gangrene may include supportive care, including fluids,
nutrients, and pain medication to relieve your discomfort.

Prognosis
Generally, people who have dry gangrene have the best prognoses because dry
gangrene doesn't involve a bacterial infection and spreads more slowly than the other
types of gangrene. However, when infected gangrene is recognized and treated
quickly, the probability of recovery is good.

Older people, those who are immunocompromised, those who have underlying
conditions, such as diabetes, atherosclerosis or some cancers, and those who have
advanced cases of gangrene by the time that they seek treatment are most likely to
suffer complications from gangrene.

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.
 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 impairs 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.