Overview
Gangrene is a medical term used to describe the death of an area of the body. It develops when the blood supply is cut off to the affected part as a result of various processes, such as infection, vascular (pertaining to blood vessels) disease, or trauma. Gangrene can involve any part of the body; the most common sites include the toes, fingers, feet, and hands.
Two major types of Gangrene exist:
Two major types of Gangrene exist:
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Dry Gangrene is caused by a reduction of blood flow through the arteries. It appears gradually and progresses slowly. In most people, the affected part does not become infected. In this type of gangrene, the tissue becomes cold and black, begins to dry, and eventually sloughs off. Dry gangrene is commonly seen in people with blockage of arteries (arteriosclerosis) resulting from increased cholesterol levels, diabetes, cigarette smoking, and genetic and other factors.
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Wet or moist gangrene develops as a complication of an untreated infected wound. Swelling resulting from the bacterial infection causes a sudden stoppage of blood flow. Cessation of blood flow facilitates invasion of the muscles by the bacteria and multiplication of the bacteria because disease-fighting cells (white blood cells) cannot reach the affected part.
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Gas Gangrene is a type of wet gangrene caused by the bacteria known as Clostridia. Clostridia are a type of infection-causing bacteria that grow only in the absence of oxygen. As Clostridia grow, they produce poisonous toxins and gas; therefore, the condition is called gas gangrene.
What are the causes of Gangrene ?
Our cells require nutrients and oxygen to survive and they get this from our blood. If their blood supply goes down below a certain level, the cells will become damaged and will eventually die.
Tissues and cells are also attacked by organisms such as bacteria, viruses, parasites and fungi. Our white blood cells and the Thymus cells (T-cells) form part of our immune system and fight germs. If the blood supply is cut there will be no white cells or T-cells to stop the organisms from multiplying and causing an infection.
What are the symptoms of Gangrene ?
Symptoms of dry gangrene :
Generally, dry gangrene develops slowly. It is the most common gangrene for patients with atherosclerosis and other vascular diseases.
- A red line appears on the skin which surrounds the affected tissue.
- The area will gradually become numb and cold.
- When necrosis (tissue death) occurs there may be some pain.
- Some patients, especially older ones, may feel nothing at all.
- The area will change from red, to brown, to black.
- The necrotized tissue then shrivels up and eventually falls off.
Gas Gangrene
Usually deep muscle tissue is affected. The surface of the skin may appear normal, but as the condition advances the skin may become pale, and then turn grey or purplish-red. Gas gangrene is usually caused by Clostridium perfringens bacteria. The bacteria multiply when the blood supply is depleted. The bacterial infection produces toxins that release a gas. Gas gangrene can become life-threatening.
- The affected area feels heavy and painful. The pain is caused by the infection which produces a gas.
- The skin may appear to bubble.
- A crackling sound when area is pressed. This sound is caused by the gas.
- Sometimes there may be a watery discharge which does not usually have a foul smell.
Internal Gangrene
The most common organs to be affected are the intestines, gallbladder, or the appendix. An infected person may have more than one affected organ. Gangrene in the intestine may be the result of a hernia; when a part of the intestine bulges through a weakened area of muscle and becomes twisted.
Patients will experience fever and pain in the affected area. Internal gangrene can be fatal if left untreated.
Fournier's Gangrene
This type is very uncommon. It affects the male genital organs. It is usually the result of a urinary tract infection or an infection in the genital area. The patient will feel pain, tenderness, and swelling in the affected area. Women can also develop Fournier's gangrene, but much less so than men. Approximately half of all people who develop this type of gangrene have diabetes.
Septic Shock
if bacteria get into the bloodstream the patient may go into septic shock - the bacteria multiply in the blood and release a toxin which harms the organs and cells. Septic shock always results in a severe drop in blood pressure.
The symptoms of septic shock include:
The symptoms of septic shock include:
- Weak and rapid pulse
- Less urine flow
- Confusion
- Pale-looking skin (pallor)
- Cold and clammy skin (during the later stages)
How is Gangrene diagnosed ?
For a proper diagnosis of gangrene the doctor will need to carry out a physical examination, study the patient's medical history, and order some clinical tests.
The GP (general practitioner, primary care physician) will firstly need to establish whether the patient has a chronic health condition, and whether any injuries may have caused the condition.
The doctor will check the affected area for skin coloration, any foul smell, and symptoms of pain.
The following tests may also be ordered:
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Blood test - if the number of white blood cells are high it could indicate that there is gangrene.
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Tissue/fluid culture - a sample of tissue or fluid from the affected area will be taken and tested for infection. When the test identifies the type of bacteria the doctor can better choose which antibiotic to use. The doctor may also look at a piece of tissue culture to determine the extent of tissue death.
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Imaging scans - MRI, CT, scans as well as X-rays may help to confirm not only the presence of gangrene, but also how much it has spread. An arteriogram can visualize the arteries and determine how well blood is flowing through the arteries - this helps the doctor identify any blockages.
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Surgery - in suspected cases of internal or gas gangrene surgery may be required to confirm a diagnosis.
Treatment for Gas Gangrene
Effective treatment includes careful observation for signs of myositis and cellulitis, immediate treatment if these signs appear, and immediate wide surgical excision of all affected tissues and necrotic muscle in myositis. Delayed or inadequate surgical excision is a fatal mistake.
Treatment also includes I.V. administration of high-dose penicillin, adequate debridement, and hyperbaric oxygenation. If a hyperbaric chamber is available, the patient is placed in the chamber for 1 to 3 hours every 6 to 8 hours and exposed to pressures designed to increase oxygen tension and prevent multiplication of the anaerobic microbes. Surgery may be done within the hyperbaric chamber if the chamber is large enough.
Treatment also includes I.V. administration of high-dose penicillin, adequate debridement, and hyperbaric oxygenation. If a hyperbaric chamber is available, the patient is placed in the chamber for 1 to 3 hours every 6 to 8 hours and exposed to pressures designed to increase oxygen tension and prevent multiplication of the anaerobic microbes. Surgery may be done within the hyperbaric chamber if the chamber is large enough.
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