Gangrene is the medical term used to describe an area of the body that has lost blood supply has has begun to die. It can result from infection, blood vessel disease or trauma. Gangrene can involve any part of the body but the most common tissues are the toes, fingers, feet and hands but can also occur in the muscles and internal organs. Some types of gangrene also include bacterial infections.
Individuals are at higher risk of developing gangrene if they had an underlying medical condition that predisposes them to damage to their blood vessels or can it keep their blood flow, such as diabetes or atherosclerosis. Symptoms of gangrene usually start suddenly and get steadily worse.
There are two different types of gangrene-dry gangrene or wet gangrene (also called gas gangrene). Individuals who suffer from dry gangrene experience infection free death of the tissue usually brought on by a blood clot, frostbite or poor circulation. Individuals who suffer from wet gangrene find that the dead tissue is a breeding ground for bacteria which thrives on the absence of oxygen. This bacterial growth causes the area to become moist and foul-smelling.
Dry gangrene can progress to wet gangrene but usually does not cause sepsis or cause the patient to die. It does result in local tissue death which eventually falls off. The progression of dry gangrene is slower then wet gangrene because the vascular compromise develops slowly and not due to a traumatic event or blood clot. Gas gangrene can happen rapidly over a couple of hours to days.
Individuals who suffer from wet gangrene always have infection, and in most cases it is caused by Clostridium perfringens. This is an anaerobic bacteria which grows best when there is no oxygen presents and produces toxins and gas bubbles in the dead and dying tissue. This leads to swelling with compression and loss of blood flow to the surrounding tissue. This causes the surrounding tissue to begin to die and be invaded by the infection, which can ultimately lead to death of the individual.
The symptoms of gangrene will vary according to the anatomic location. Those who experience dry gangrene will have cool areas where the gangrene is developing. The discomfort will vary with the patient\’s perception of pain and the area will slowly began to discolor, usually turning from red to Brown and eventually to black. During this time the area shrinks and may fall off of the body.
In contrast wet gangrene will begin with swelling and a very painful area that is initially red but will show signs of decay. Often the fluid and the affected area will have a very bad smell and the tissue develops a black appearance. Patients may also have fever and other signs of sepsis.
Treatment of this condition will depend upon the type, the subtype, how much tissue is compromised and how far along the condition has progressed. Immediate treatment is needed in all individuals who suffer from wet gangrene. These treatment protocols may involve surgery or medical treatment with supportive care and occasionally rehabilitation therapy.
Dry gangrene is usually treated with surgical removal of the area and possible amputation of a limb. How much is removed will depend upon how much arterial flow is still available to the surrounding tissue. Patients will be given prophylactic antibiotics to prevent infection and may receive anti-coagulants to reduce blood clots.
Wet gangrene is a medical emergency and requires immediate treatment. A surgeon will need to be involved for débridement\’s and possible amputation of the limb. Intravenous antibiotics will be administered and patients will be monitored closely for sepsis.
Those individuals who experienced a limb amputation will also require rehabilitation therapy in order to be able to resume daily activities in an independent and functional manner.
Individuals who have diseases which are known to compromise arterial flow such as diabetes, peripheral neuropathy, peripheral vascular disease or are at risk for exposure to frostbite should take preventative measures in order to ensure adequate oxygenation and arterial flow to all areas of their body. This means avoiding tobacco use or other medications which may compromise the circulatory system or by avoiding working outside during times of the year when frostbite is a risk.
Individuals who suffer from diabetes should keep their glucose under good control and patients who have diabetic neuropathy should inspect their toes and feet daily in order to catch any small cuts or bruises early.
Gangrene can be a life-threatening condition when it involves in a matter which increases the risk for infection. In either case the removal of the dead tissue should be done by a surgeon and treatment must be done under the care of an individual\’s primary care physician or surgeon in order to ensure the best possible and results and ability to return to normal daily activities.
RESOURCES
PubMed Health: Gangrene
MedLine Plus: Gangrene
MayoClinic: Gangrene