Gangrene

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 28, 2016
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Gangrene is a condition that involves the death of body tissue. This condition forms as a result of either a lack of blood flow or a bacterial infection. Though it can form in anyone, gangrene typically forms in people who have an underlying condition that damages blood vessels, such as diabetes

Contents

Definition & Facts

Though it most commonly affects the extremities, such as the the fingers, toes, and limbs, gangrene can also affect the muscles and internal organs. It exists in two forms: wet gangrene and dry gangrene. Dry gangrene occurs when blood flow is blocked in the arteries. It’s called dry gangrene because it typically will cause patches of skin to become dry and discolored.

Wet gangrene is caused by an infection, but this infection can also be caused by blood flow that is blocked in the arteries. The reason it’s called wet gangrene is that it usually involves the oozing of pus or fluid from the infection. Wet gangrene is more fatal than dry gangrene. 

Symptoms & Complaints

Gangrene is a reasonably simple condition to spot, as its symptoms are fairly obvious. One of these symptoms is skin that is clearly of a different consistency than the rest of a person’s skin. Skin that looks completely different than its surrounding skin is more than likely damaged. This skin will also be discolored and present itself in one of several colors, including pale, blue, purple, black, and red. Each different color reflects a different type of gangrene.

Other symptoms are a foul-smelling discharge from the infected area as well as terrible pain followed by numbness. In some cases, the gangrene will affect the tissues under a person’s skin. In these cases, the person will develop a fever and have swollen and irritated tissue where the infection is present. These symptoms usually result from gas gangrene or internal gangrene.

If these symptoms exist and are not going away, medical assistance should be sought immediately. Untreated gangrene can lead to a potentially fatal condition known as septic shock, which is when the bacterial infection that resulted in the gangrene spreads to other parts of the body. Symptoms of septic shock include fever, low blood pressure, rapid heart rate, dizziness, shortness of breath, and in some cases, death. 

Causes

There are six major types of gangrene: dry gangrene, wet gangrene, gas gangrene, internal gangrene, Fournier gangrene, and progressive bacterial synergistic gangrene. Each of these gangrenes is caused by either infection or lack of blood flow to the skin and tissue. Dry gangrene, which is when skin becomes dry, cold, and discolored, results from a lack of blood flow. It commonly occurs in people with a disease of the blood vessels.

Wet gangrene occurs when a bacterial infection exists in the area of skin that’s infected, causing the skin to become wet, and discharging pus. It often occurs after a bad injury, such as a burn or frostbite. Gas gangrene most commonly occurs when a bacterial infection called Clostridium perfringens infects a deep muscle in the body. This type of infection usually develops in a wound from an injury or a wound from surgery, and releases gases that make the skin bubble.

Internal gangrene is caused by lack of blood flow to internal organs, such as the intestines or appendix. The lack of blood flow will cause tissue in the organ to become decayed. Fournier’s gangrene is a condition in which the genitals are attacked. Though it’s most common in men, it can also occur in women, and is caused by an infection in or around the genitals.

Also called Meleney’s gangrene, progressive bacterial synergistic gangrene is the rarest type of gangrene, and it usually comes after a medical operation of some kind. It results in painful skin lesions that usually appear two to three weeks after the operation. In extremely rare but serious cases, the anticoagulant drug, wayfarin has been shown to cause gangrene, a condition called Wayfarin necrosis.

Diagnosis & Tests

Though gangrene can often be diagnosed on sight alone, there are also numerous tests that might be performed to detect the existence of gangrene. A blood test might be performed to find the number of white blood cells in the patient’s body. A high white blood cell count is indicative of an infection.

Several forms of imaging testing, such as X-rays, MRIs, and CT scans may be performed to see the inside of the patient’s body, and determine how far the gangrene has spread. Another test that may be performed is an arteriogram, which is when dye is injected into the patient’s bloodstream, and an X-ray is used to determine how strong his or her blood flow is. In some cases, doctors may take a fluid culture or tissue sample (biopsy) and examine it under a microscope for evidence of bacteria and cell death

Treatment & Therapy

Unfortunately, once tissue has been damaged by gangrene, there is nothing that can be done to save it. The only thing that can be done is to prevent the infection from spreading further and damaging more tissue. This can be done in several ways. One way is surgery, which may consist of removing the dead tissue and preventing the infection from spreading, skin grafts which will replace dead skin with living skin, and amputation of toes, fingers, and other limbs in rare cases.

Another way of preventing the spread of gangrene is antibiotics which are given intravenously. In some cases, hyperbaric oxygen therapy may be used. This therapy consists of putting the infected person in a pure oxygen chamber for around an hour and a half. The increased oxygen in the blood will work to stave off the growth of bacteria. 

Prevention & Prophylaxis

There are several preventable conditions that increase a person's chances of developing gangrene. These conditions are diabetes, cardiovascular diseases such as atherosclerosis, smoking, obesity, and any type of skin trauma.

It's important to avoid these conditions by practicing safe and healthy living habits. That includes healthy diet, regular exercise, and quitting smoking or never starting to begin with.

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