Gangrene - Types, Symptoms, and Treatment

What Is Gangrene?

Gangrene is a condition that occurs when blood supply is cut off to a significant area of body tissue. It is a dangerous and potentially fatal condition that causes tissue breakdown, death, and a greenish-black discoloration of the affected skin. Gangrene originates from Greek and Latin words translating to a gnawing sore or decayed tissue. Gangrene usually affects the extremities like the toes and fingers. However, other parts of the body, like the internal organs, can be affected. The condition typically begins in a specific body part, such as a hand, leg, or internal organ, and can spread throughout your body and may lead to septic shock if left untreated. Septic shock can be potentially life-threatening and should be considered a medical emergency. Recognizing the symptoms and treating gangrene as soon as possible will improve the prognosis.

What Are the Different Types of Gangrene?

There are different types of gangrene, which include:

1. Dry Gangrene:

The blood carries oxygen to all major organs like the heart, liver, and muscles. These organs require oxygen to function efficiently and survive. When a body part is not receiving enough oxygen, it results in a condition known as dry gangrene that leads to the deterioration (becomes dry, discolored, and shrinks) and death of the affected tissue. In the case of dry gangrene, the skin is usually unaffected, and there is no evidence of infection. The most common cause of dry gangrene is arteriosclerosis (buildup of fatty deposits on the artery walls).

2. Wet Gangrene:

Wet gangrene occurs due to infection of the tissue with some bacteria. The tissue responds to this infection by developing moisture and breaking down, leading to the death of tissues. Wet gangrene is more dangerous than dry gangrene because the possibility of the disease spreading to other parts of the body is higher. In addition, the affected area is swollen with fluid, and when the fluid is drained, it often contains an odor.

3. Gas Gangrene:

Gas gangrene is caused by the bacteria called Clostridium perfringens. The infection with Clostridium perfringens develops toxins and gas bubbles inside the affected area leading to the death of the tissue. This type of gangrene is excruciating and can lead to death. The occurrence of gas gangrene is rare in the United States, where only about 1,000 people develop gas gangrene each year. If gas gangrene is not untreated, it has a 100 percent chance of causing death. However, if timely medical intervention is done, the death rate can be as low as five to ten percent.

4. Fournier’s Gangrene:

This gangrene occurs when the penis, scrotum, or perineal (genital and anal) area has an infection.

5. Internal Gangrene:

This gangrene occurs when the blood flow is blocked to specific internal organs like the intestines, gallbladder, or appendix.

Who Is at Risk of Developing Gangrene?

A person is more likely to develop gangrene if they have a history of certain medical conditions, including:

• Atherosclerosis or Peripheral Arterial Disease: When patients have these conditions, the blood flow to the artery is restricted because of fat deposits.

• Diabetes Mellitus: Diabetes mellitus leads to the damage of nerves and blood vessels, which results in delayed wound healing. This, in turn, increases the risk of infections, especially in the foot. In diabetics, this infection is known as a diabetic foot ulcer.

• Raynaud’s Syndrome: Raynaud’s syndrome is a condition in which the blood vessels in the fingers and toes react by constricting to cold temperatures. This narrowing of blood vessels causes a decrease in blood flow to digits.

• Complex Injuries: The skin and tissues can suffer from trauma (crush injuries), burns, and frostbite that can lead to the loss of blood in the area, causing tissue damage and increased risk of infection.

• Compromised Immune System: Even minor infections and wounds can lead to gangrene in individuals with a compromised immune system and chronic medical illnesses like diabetes, infectious diseases, older age, cancer, alcoholism, or drug abuse.

What Are the Symptoms of Gangrene?

Symptoms of gangrene vary based on location and etiology. The general symptoms of gangrene are:

• Coldness and numbness in the affected area.

• Redness and swelling around a wound, especially with wet gangrene.

• Pain beyond the affected area.

• Persistent fever with a temperature higher than 100.4°F.

• Sores that recur in the same place.

• Noticeable discoloration of the skin ranges from greenish-black, blue, red, or bronze.

• A foul-smelling discharge from the wound.

• Blisters under the skin.

• Shock.

• Confusion, pain, fever, and low blood pressure.

What Is the Treatment of Gangrene?

There are various treatment options available, and they include:

1. Tissue Debridement - In severe cases of gangrene, the affected tissue or body part may need to be removed through a process called debridement. Debridement is usually done with surgical tools or with chemicals. This procedure aims to remove the affected tissues to prevent the spread of infection to other unaffected tissues. A rare and alternative form of debridement that uses fly larvae to eat away bacteria and dead tissue is maggot debridement, which is used by physicians in the United States and other countries. The flow of blood to the gangrene-affected area can be restored sometimes. Skin grafts can be performed by using a piece of healthy skin to cover the affected area to repair and restore the damaged tissue.

2. Antibiotics - Antibiotics can be prescribed to inhibit and destroy the bacteria causing infection.

3. Vascular Surgery - If inadequate blood circulation causes gangrene, then vascular surgery (surgery on the arteries or veins) may be advised to improve the blood flow to body tissues.

4. Hyperbaric Oxygen Chamber - Hyperbaric oxygen chamber creates a special oxygen-rich environment that can slow the growth of bacteria and allow the affected skin to heal.

5. Amputation - In severe cases, only amputation of a limb, finger, or toe could save the patient’s life. Post-surgery these patients are often fitted with a prosthesis, or artificial limb, to replace the missing body part.

Conclusion:

Gangrene needs to be treated as early as possible for successful treatment outcomes. In the early stages, gangrene can be treated without severe complications. However, in delayed intervention and complex cases, the patient may require amputation, and in rare cases, the patient may die. Therefore once the patient notices the symptoms of gangrene, it is best if they seek medical treatment.

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