Gangrene

Submitted by
Ayesha Imtiaz
70122032
Submitted to
Sir Saif Ullah
Community (NUR 316)
Bachelor of Science in Nursing

Lahore School of Nursing

Faculty of Allied Health Sciences
The University of Lahore

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 Table of content

Sr. # Content Page. #

01 Title page 01
02 Table of contents 02
03 Objectives 03
04 Introduction 04
05 Definition 04
06 Pathophysiology 05-06
07 Types of gangrene 06-08

08 Clinical Manifestation 09-11

09 Risk factors 11-12
10 Diagnoses 13-14
11 Treatment 14-15
12 Complications 16-17
13 Preventions 17-18
14 Nursing care plan 19-20

15 Summary 21-22
16 References 22

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Objectives
➢ Introduction of gangrene
➢ Definition of gangrene
➢ Pathophysiology of gangrene
➢ Types of gangrene
➢ Clinical manifestation of gangrene
➢ Risk factors of gangrene
➢ Diagnoses of gangrene
➢ Treatment of gangrene
➢ Complications of gangrene
➢ Preventions of gangrene
➢ Nursing care plan
➢ Summary
➢ References

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Introduction:
Gangrene is the death of body tissue due to a lack of blood flow or a serious bacterial
infection. It commonly affects the arms and legs, including the toes and fingers. It
can also occur in the muscles and organs inside the body, such as the gallbladder. It
is typically caused by an interruption in blood flow to a specific area, leading to
tissue damage and eventual necrosis. A condition that can damage the blood vessels
and affect blood flow, such as diabetes or hardened arteries (atherosclerosis),
increases the risk of gangrene.

Definition:

Gangrene is a medical condition characterized by the death or decay of body tissues

due to a lack of blood supply or bacterial infection. It is a serious and potentially
life-threatening condition that typically occurs when blood flow to a specific area is
interrupted, leading to tissue damage and eventual necrosis.

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Pathophysiology:
The pathophysiology of gangrene involves a combination of vascular compromise,
infection, and tissue necrosis.

✓ Vascular compromise: Gangrene often develops as a result of reduced blood

flow to the affected area. This can be caused by various factors, including
arterial blockage or obstruction, severe injury, diabetes-related vascular
complications (such as peripheral artery disease), or blood vessel
inflammation (vasculitis). Reduced blood flow deprives the tissues of oxygen
and nutrients necessary for their survival.
✓ Ischemia: The reduced blood flow leads to ischemia, a condition where
tissues do not receive adequate oxygen and nutrients. Ischemia results in
tissue hypoxia, or oxygen deprivation, which triggers a cascade of events
leading to cellular damage and death.
✓ Tissue necrosis: Without sufficient oxygen and nutrients, cells in the affected
area cannot produce enough energy to maintain their normal functions. As a
result, the cells undergo necrosis, a form of cell death characterized by
irreversible damage to the cellular structures. Necrotic tissues appear
discolored, black, or darkened, which is a typical visual characteristic of
gangrene.
✓ Infection: In some cases, gangrene may become complicated by infection.
The necrotic tissue provides an ideal environment for the growth of bacteria
and other microorganisms. These infectious agents can further damage the
surrounding healthy tissues and accelerate the progression of gangrene.

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 ✓ Spread and systemic effects: If the infection associated with gangrene is not
treated promptly, it can spread to surrounding tissues or enter the bloodstream,
causing a systemic infection known as sepsis. Sepsis is a severe condition that
can lead to organ failure and life-threatening complications.

Types of gangrene

There are several types of gangrene, each classified based on different factors such
as the underlying cause, clinical presentation, and location. The main types of
gangrene include:

1. Dry gangrene (also known as ischemic gangrene):

Dry gangrene occurs when there is an inadequate blood supply to a specific area,
leading to tissue death. It commonly affects the extremities, such as the fingers, toes,
or limbs. Dry gangrene typically develops slowly and is often associated with
conditions like peripheral artery disease or diabetes.

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2. Wet gangrene (also known as moist gangrene):

Wet gangrene typically occurs when there is an interruption of

blood supply combined with a bacterial infection. It can
develop rapidly and is characterized by tissue necrosis
accompanied by bacterial invasion. The affected area becomes
swollen, discolored, and moist. Wet gangrene commonly
affects internal organs or areas with high moisture content,
such as the gastrointestinal tract, lungs, or genitourinary
system.

3. Gas gangrene (also known as clostridial myonecrosis):

Gas gangrene is a severe and potentially life-threatening form of gangrene caused

by infection with certain bacteria,
predominantly Clostridium species (e.g.,
Clostridium perfringens). These bacteria
produce gas and toxins that destroy the
surrounding tissues. Gas gangrene often occurs
after traumatic injuries, deep wounds, or surgical
procedures. It is characterized by rapid tissue
destruction, the presence of gas bubbles within
the affected tissues, severe pain, and systemic toxicity.

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4. Fournier's gangrene:

Fournier's gangrene is a type of necrotizing fasciitis that

affects the genital and perineal regions. It is most
commonly seen in males but can also occur in females.
Fournier's gangrene is often caused by bacterial infection,
typically originating from the urinary or gastrointestinal
tract. It is characterized by rapidly progressing tissue
necrosis, severe pain, swelling, and systemic signs of
infection.

5. Internal gangrene:

Internal gangrene refers to gangrene that affects

internal organs or tissues. It can occur due to
various causes, such as vascular compromise,
infection, or obstruction. Internal gangrene may
affect organs like the intestines (intestinal
gangrene), appendix (appendiceal gangrene),
gallbladder (gangrenous cholecystitis), or other
hollow organs. It often requires surgical
intervention.

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Clinical Manifestation:

The clinical manifestations of gangrene can vary depending on the type and location
of the condition. Here are the common clinical manifestations associated with each
type:

1. Dry gangrene:

✓ Skin discoloration: The affected area typically appears dry, shriveled, and
discolored. Initially, it may turn pale or bluish, progressing to a dark brown or
black color.
✓ Loss of sensation: The area may lose sensation, and the patient may
experience numbness or tingling.
✓ Pain: Initially, there may be mild to moderate pain in the affected area.
However, as the nerve endings become damaged, the pain may subside.

2. Wet gangrene:

✓ Skin changes: The affected area appears swollen, discolored (dark red,
purple, or black), and wet. Blisters may form, which can rupture and release
foul-smelling fluid.
✓ Increased pain: Wet gangrene is often associated with intense pain due to the
presence of infection and tissue inflammation.
✓ Systemic signs of infection: Patients may experience fever, chills, rapid heart
rate, and general malaise.

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3. Gas gangrene:

✓ Severe pain: Gas gangrene is characterized by a severe, throbbing pain in the

affected area. The pain may worsen rapidly.
✓ Crepitus: A crackling sensation or sound (crepitus) may be felt when
pressing on the affected area due to the presence of gas produced by certain
bacteria.
✓ Systemic toxicity: Patients may exhibit signs of systemic toxicity, including
fever, rapid heart rate, low blood pressure, confusion, and dizziness.

4. Internal gangrene:

Internal gangrene refers to gangrene that affects internal organs and may not have
visible external manifestations. Its symptoms depend on the specific organ affected
and can vary widely. Some common signs include severe abdominal pain, organ
dysfunction, fever, and systemic signs of infection.

5. Fournier’s gangrene:

✓ Pain and discomfort: Patients often experience severe pain and tenderness
in the affected genital and perineal area. The pain may be out of proportion to
the visible signs initially.
✓ Swelling and erythema: The affected area becomes swollen, red, and
inflamed. The swelling may rapidly progress and extend to nearby regions.
✓ Skin changes: The skin over the affected area may appear dusky, discolored,
or dark purple. It may have a tense and shiny appearance.
✓ Crepitus: Crepitus refers to the presence of a crackling or popping sensation
felt on palpation due to the accumulation of gas within the tissues. It is a
characteristic finding in Fournier's gangrene and suggests the presence of gas-
forming bacteria.
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 ✓ Foul odor: Gangrenous tissue produces a foul-smelling odor due to the
presence of bacteria and tissue necrosis. This odor may be noticed by the
patient or healthcare providers.
✓ Blisters or bullae: In some cases, large fluid-filled blisters or bullae may
develop on the skin surface overlying the affected area.
✓ Systemic symptoms: As Fournier's gangrene progresses, patients may
develop systemic symptoms, such as fever, chills, malaise, and generalized
weakness. These symptoms are indicative of a severe infection and systemic
inflammatory response.
✓ Rapid progression: Fournier's gangrene has a rapid course, with the infection
spreading rapidly to adjacent tissues and potentially affecting multiple fascial
planes.

Risk factors:

Several risk factors can increase a person's susceptibility to developing gangrene.

These risk factors include:

1. Poor circulation: Reduced blood flow or compromised circulation is a significant

risk factor for gangrene. Conditions such as peripheral artery disease (PAD),
atherosclerosis, diabetes-related vascular complications, blood vessel inflammation
(vasculitis), or venous insufficiency can impair blood flow to the extremities or
organs, increasing the risk of gangrene.

2. Trauma or injury: Severe traumatic injuries, crush injuries, burns, frostbite, or

deep wounds can disrupt the blood supply to the affected area, leading to tissue
damage and potential gangrene.

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3. Diabetes: Individuals with diabetes have an increased risk of developing gangrene
due to various factors. Diabetes can lead to peripheral artery disease, nerve damage
(neuropathy), and impaired wound healing, making them more susceptible to tissue
damage and infection.

4. Infection: Infections that are left untreated or poorly managed can increase the
risk of gangrene. Bacterial infections, such as those associated with deep wounds,
surgical sites, or conditions like necrotizing fasciitis, can contribute to tissue death
and gangrene development.

5. Immunocompromised state: People with weakened immune systems, such as

those with HIV/AIDS, undergoing chemotherapy, or taking immunosuppressive
medications, are more susceptible to infections. Infections that are not adequately
controlled can progress to gangrene.

6. Smoking: Smoking damages blood vessels and impairs circulation, increasing the
risk of gangrene development, particularly in the extremities.

7. Age and underlying medical conditions: Advanced age, especially in

combination with other underlying medical conditions like heart disease, kidney
disease, or peripheral artery disease, can increase the risk of gangrene.

8. Substance abuse: Illicit drug use, particularly intravenous drug use, can introduce
infectious agents into the body, increasing the risk of gangrene, especially if injecting
drugs with unsterilized equipment.

9. Raynaud's disease: Raynaud's disease is a condition characterized by the

narrowing of blood vessels in response to cold temperatures or stress, leading to
reduced blood flow. Severe or prolonged episodes of reduced blood flow may
increase the risk of gangrene.

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Diagnoses:

The diagnosis of gangrene typically involves a combination of medical history,

physical examination, and imaging tests. The following diagnostic approaches are
commonly utilized:

1. Medical history and physical examination: The healthcare provider will

assess the patient's symptoms, medical history, and risk factors associated with
gangrene. They will also perform a thorough physical examination, paying attention
to the affected area and looking for signs such as skin discoloration, swelling, pain,
or the presence of blisters.

2. Imaging tests: Various imaging techniques may be employed to evaluate blood

flow and tissue viability in the affected area. These tests include:

✓ Doppler ultrasound: This non-invasive test uses sound waves to assess blood
flow in the arteries and veins. It can help identify any blockages or
compromised circulation.
✓ Magnetic resonance imaging (MRI) or computed tomography
(CT) scan: These imaging modalities provide detailed images of the
affected area, aiding in the assessment of tissue damage, infection, and blood
flow.
✓ Angiography: In this procedure, a contrast dye is injected into the blood
vessels, and X-ray images are taken to visualize blood flow and identify any
blockages or narrowing of the blood vessels.

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3. Laboratory tests: Blood tests may be conducted to evaluate the patient's overall
health and identify any signs of infection or inflammation. These tests may include
a complete blood count (CBC), blood cultures, and inflammatory markers like C-
reactive protein (CRP) or erythrocyte sedimentation rate (ESR).

4. Biopsy: In some cases, a small sample of the affected tissue may be taken for
analysis (biopsy) to confirm the presence of gangrene, determine the cause, and
assess for any underlying infections.

5. Cultures: If the infection is suspected, samples from the affected area, such as
wound swabs or tissue samples, may be sent for culture and sensitivity testing. This
helps identify the specific microorganisms causing the infection and determine
appropriate antibiotic treatment.

Treatment:

The treatment of gangrene depends on the type, location, and severity of the
condition. The following treatment approaches are commonly employed:

1. Surgical debridement: The primary treatment for gangrene involves surgical

removal (debridement) of the necrotic tissue. This helps to eliminate a source of
infection and promote wound healing. In severe cases, amputation of the affected
limb or organ may be necessary to prevent the spread of infection and save the
patient's life.

2. Antibiotics: Antibiotics are typically administered to treat or prevent infection

associated with gangrene. The choice of antibiotics depends on the causative
organisms, and a combination of broad-spectrum antibiotics may be used initially

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until culture results are available. In gas gangrene, specific antibiotics effective
against the causative bacteria, such as Clostridium perfringens, are used.

3. Revascularization: If the underlying cause of gangrene is impaired blood flow

(such as in peripheral artery disease), revascularization procedures may be
performed. These procedures aim to restore blood supply to the affected area.
Techniques may include angioplasty, stenting, or bypass grafting.

4. Hyperbaric oxygen therapy (HBOT): HBOT involves breathing pure oxygen

in a pressurized chamber. It helps increase the oxygen levels in the blood, promoting
wound healing and fighting infection. HBOT may be used as an adjunct therapy for
selected cases of gangrene, particularly in certain types, such as gas gangrene.

5. Wound care and dressings: Proper wound care is essential for managing
gangrene. This involves cleaning the wound, applying appropriate dressings, and
ensuring a moist wound environment to promote healing. Advanced wound
dressings and techniques may be employed, such as negative pressure wound
therapy (NPWT), to facilitate wound healing and reduce infection.

6. Supportive care: Patients with gangrene may require supportive care to manage
pain, maintain hydration, and address systemic complications. This may include pain
medications, intravenous fluids, and close monitoring of vital signs.

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Complications:

Gangrene is a serious condition that can lead to various complications, some of

which can be life-threatening. The complications associated with gangrene include:

1. Sepsis: Gangrene often occurs in the presence of infection. If the infection spreads
to the bloodstream, it can lead to sepsis, a severe and potentially life-threatening
condition. Sepsis can cause systemic inflammation, and organ dysfunction, and can
progress to septic shock.

2. Organ failure: Gangrene-related infection and sepsis can result in organ failure.
The infection can spread to vital organs, such as the lungs, heart, or kidneys, leading
to their dysfunction and compromising their ability to perform essential functions.

3. Amputation: In cases where gangrene affects an extremity, such as a finger, toe,

or limb, it may progress to a point where amputation is necessary. Amputation
involves the surgical removal of dead or severely damaged tissue to prevent the
spread of infection and save the patient's life.

4. Tissue loss and disfigurement: Gangrene can cause significant tissue loss,
leading to disfigurement or deformity. In cases where large areas of tissue are
affected, reconstructive surgery or skin grafting may be necessary to restore function
and appearance.

5. Secondary infections: Gangrene can increase the risk of secondary infections,

both in the affected area and in other parts of the body. These infections can further
complicate the condition and require additional treatment.

6. Delayed wound healing: Gangrene can impair the body's natural healing process.
Even after surgical intervention and removal of the dead tissue, wound healing may

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be delayed, and the risk of wound complications, such as infection or poor wound
closure, may be increased.

7. Psychological impact: The physical and emotional toll of gangrene, including

amputation, disfigurement, and prolonged hospitalization, can have a significant
psychological impact on individuals. Depression, anxiety, and adjustment
difficulties are common in individuals recovering from gangrene.

Preventions:

Preventing gangrene involves addressing the underlying risk factors and adopting
preventive measures to minimize the chances of tissue damage and infection. Here
are some key prevention strategies:

1. Good hygiene and wound care: Practicing good hygiene and proper wound care
are essential in preventing gangrene. Keep wounds clean by washing them with mild
soap and water, and cover them with sterile dressings.

2. Diabetes management: If a person has diabetes, it is crucial to manage his/her

blood sugar levels effectively to reduce the risk of complications, including
peripheral artery disease and impaired wound healing.

3. Smoking cessation: Smoking damages blood vessels and impairs circulation,

increasing the risk of gangrene. Quitting smoking is crucial to improve overall
vascular health and reducing the chances of developing gangrene.

4. Foot care for individuals with diabetes: If a person has diabetes, pay special
attention to foot care. Inspect his/her feet daily for any cuts, blisters, or sores. Keep

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his/her feet clean and moisturized, and wear comfortable, properly fitting shoes to
prevent pressure points and reduce the risk of foot ulcers.

5. Proper nutrition and hydration: Maintaining a healthy diet and staying

hydrated are important for overall health and tissue integrity. Adequate nutrition and
hydration support proper wound healing and reduce the risk of infection.

6. Regular exercise: Engaging in regular physical activity improves blood

circulation and overall cardiovascular health. Consult with the healthcare provider
to determine the appropriate exercise regimen for his /her condition.
7. Early detection and management of peripheral artery disease (PAD):
Peripheral artery disease is a significant risk factor for gangrene. Be aware of the
signs and symptoms of PAD, such as leg pain or cramping during exercise, and seek
medical attention if experience any concerning symptoms.

8. Prompt treatment of infections: Any infections, including skin infections,

wounds, or respiratory infections, should be promptly diagnosed and treated. Follow
medical advice regarding appropriate antibiotics and wound care to prevent the
progression of infection to gangrene.

9. Regular medical check-ups: Regular medical check-ups allow for the early
detection and management of underlying conditions that increase the risk of
gangrene, such as diabetes, peripheral artery disease, or autoimmune disorders.

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 Nursing Care Plan

Assessment Diagnosis Planning Implementation Evaluation

Subjective
Impaired 1. Change dress
Short-term
data: 1. Patient verbalizes
skin integrity wounds daily to
The patient goal:
related to keep skin dry and the importance of
complains of After 4 hours
necrotic intact. turning schedules to
pain of 4 on a of nursing
tissue as minimize the risk of
intervention, 2. Encourage
scale of 0-10. pressure sores.
evidenced by proper hydration to
Objective the patient
eschar. 2. Patient and family
will be able to avoid further skin
data: verbalize the
verbalize the breakdown and the
Vitals:
importance of development of new importance of the
RR- 4bpm septic method of
patient turning ones.
HR-65 bpm wound care to reduce
to minimize 3. Set a turning
BP-110/70 the spread of infection.
the risk of schedule to prevent
mmHg
pressure sores. pressure sores.
Sats. –98% R.A
4. Assess the skin
Pt. appears
Long-term for its integrity,
comfortable with
goal: color, moisture, and
no distress
The patient texture for any
noted. The
will be able to further
wound dressing
experience deterioration.
was changed.
optimal
Wound

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measurement is wound 5. Teach the client
5x5 and eschar healing and about skin and
throughout. avoid the wound assessment
Moderate odor spread of and ways to monitor
due to necrotic infection to for signs and
tissue. the rest of the symptoms of
skin to infection,
preserve its complications, and
integrity. healing.
6. Teach patient and
family aseptic
methods such as
hand washing with
wound care.

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Summary:

Gangrene is a serious medical condition that occurs when body tissues die due to a
lack of blood supply or bacterial infection. It can affect any part of the body but
commonly occurs in the extremities, such as the fingers, toes, or limbs. There are
several types of gangrene, including dry gangrene, wet gangrene, and gas gangrene,
each with different causes and characteristics.

The primary causes of gangrene include arterial blockages, such as peripheral artery
disease or diabetes, trauma or injury that disrupt blood flow, severe infections, and
compromised immune function. Common symptoms of gangrene include
discoloration of the affected area, severe pain, swelling, foul-smelling discharge, and
the presence of necrotic or dead tissue.

Gangrene requires immediate medical attention and treatment to prevent further

tissue damage and potential complications, including sepsis or organ failure.
Treatment may involve surgical interventions, such as debridement to remove dead
tissue, revascularization procedures, or amputation in severe cases. Antibiotics are
often prescribed to control infections, and pain management strategies are employed
to alleviate discomfort.

Nursing care for gangrene patients focuses on wound care, pain management,
infection control, patient education, and psychosocial support. Regular assessments
of the wound, vital signs, and the patient's overall condition are essential. Wound
care involves cleaning the wound, applying sterile dressings, and monitoring for
signs of improvement or deterioration. Pain management includes administering
medications and implementing non-pharmacological techniques. Infection control
measures aim to prevent the spread of infection and ensure appropriate antibiotic
administration. Patient education helps them understand their condition, treatment

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options, and self-care techniques. Psychosocial support involves addressing
emotional well-being and involving the patient's family in the care process.

References

1. Rani, M., Schwentker, A., & Khan, S. A. (2021). Gangrene. In StatPearls

[Internet]. StatPearls Publishing.

2. Dalla Paola, L., Carone, A., Ricci, S., & Volpe, A. (2019). Gangrene: etiology,
classification, clinical presentation, diagnosis, and management. In Current
Problems in Dermatology (Vol. 55, pp. 43-60). Karger Publishers.

3. Mayo Clinic. (2022, February 10). Gangrene.

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