Gangrene Introduction Gangrene is the death of tissues in your body. It happens when a part of your body loses its blood supply. Gangrene can happen on the surface of the body, such as on the skin. It can happen inside the body in muscles or organs. Gangrene can be caused by a number of health problems, including serious injuries, infections, problems with blood circulation and diabetes. This reference summary explains what gangrene is and what causes it. It also covers the diagnosis and treatment of gangrene. Gangrene Gangrene is the death of tissues in your body. It may be caused by a lack of blood flow to a part of the body or by a bacterial infection. Blood helps distribute the nutrients, oxygen and hormones the body needs. It also carries toxins and waste materials to the liver and kidneys to be removed from your body. When blood flow is blocked, the body suffers. Tissues die if they don t get the oxygen and nutrients carried by the blood. When this happens, health problems like gangrene can develop. The Circulatory System There are 2 main types of gangrene: Dry gangrene, which is caused by diseases that affect blood circulation. Wet gangrene, which is caused by a wound infected with bacteria. Gangrene 1
Gangrene may be described with names other than dry or wet depending on where or how it develops. For example, wet gangrene that is caused by the bacteria Clostridia is called gas gangrene. It gets its name from a poisonous gas released by the Clostridia bacteria. Any body part can be affected by gangrene, but it most often develops in the hands, feet, fingers and toes. Gangrene can also happen inside of your body, in the muscles and organs. Symptoms When gangrene is located on the skin, symptoms may include: Discolored skin, which may appear blue, purple, black, bronze or red. Foul-smelling discharge from a wound or sore. Severe pain in the affected area followed by numbness, or a loss of sensation. When gangrene is located beneath the surface of the skin, symptoms may include: Feeling sick or ill. Fever. Swelling and pain in the affected area. If bacteria move from the affected tissue and infect other tissues throughout the body, it may cause septic shock. Symptoms of septic shock are: A temperature greater than 100.4 Fahrenheit or lower than 96.8 Fahrenheit. Confusion. Lightheadedness. Low blood pressure. Rapid heart rate. Shortness of breath. Call your health care provider right away if you have ongoing, unexplained pain in any area of your body along with one or more of the following symptoms: Fever. Skin changes that won t go away, including discoloration, warmth, swelling, blisters or lesions. 2
You should also contact your health care provider if you have ongoing, unexplained pain and one or more of these symptoms: A foul-smelling discharge leaking from a sore. Skin that is pale, hard, cold and numb. Sudden pain at the site of a recent surgery or trauma. Causes Gangrene is caused by one or both of the following: Lack of blood supply. Bacterial infection. Health care providers use different names for gangrene based on its cause or location. The three most common causes include: Dry gangrene, which is caused by blood vessel diseases. Wet gangrene, which is caused by a bacterial infection or diabetes. Gas gangrene, which is caused by infection with the bacterium Clostridium. Other, less common, causes of gangrene are given different names: Internal gangrene. Fournier's gangrene. Meleney's gangrene. Internal gangrene happens when blood flow to an internal organ is blocked. For example, internal gangrene may develop after a hernia. A hernia happens when the intestines push through a weakened area of muscle in your abdomen. Internal gangrene most often affects the intestines, gallbladder or appendix. Fournier's gangrene is a rare type of gangrene caused by an infection in the genital area or urinary tract. It involves the genital organs. Men are more often affected, but women can also develop this type of gangrene. Meleney s gangrene is also known as bacterial synergistic gangrene. It is a rare type of gangrene caused by a bacterial infection after a surgical operation. Painful skin lesions develop one to two weeks after surgery. Bacterial synergistic gangrene is caused by the interaction of two or more bacteria. Their combined effect is greater than the effects seen when each bacteria acts alone. 3
Risk Factors Health care providers know of several factors that increase your risk for gangrene. Having a risk factor does not mean you will develop gangrene. But you are more likely to develop it than somebody without a risk factor. Sometimes people with no risk factors develop gangrene. One risk factor for gangrene is age. People older than 60 years of age are diagnosed with gangrene more often than younger people. As people get older, their heart and blood vessels change. Blood may have a harder time getting to the tissues that need it most. This raises the risk for gangrene. Having diabetes is another risk factor. Diabetes prevents your body from getting rid of a special kind of sugar in your blood. High blood sugar levels can damage blood vessels and interrupt blood flow to some parts of the body. This raises the risk for gangrene. People that suffer a severe injury or undergo surgery have an increased risk for gangrene. Any time something causes trauma to your skin and the tissue underneath it, such as trauma from frostbite or burns, the risk for gangrene increases. Obesity is also a risk factor. Obesity is linked to health problems related to gangrene, including diabetes and vascular disease. The stress of extra weight may constrict arteries, which also reduces blood flow. Reduced blood flow increases the risk of infection and causes wounds to heal poorly. Another risk factor for gangrene is having a weakened immune system. Immune systems may become weak due to diseases, such as HIV/AIDS, or certain medical treatments. For example, chemotherapy and radiation therapy reduce the body s ability to fight off infection. Certain blood thinning medications can also raise the risk for gangrene, but this is rare. Warfarin, also known as Coumadin, is an example of a commonly used blood thinning medication. Talk to your health care provider to find out if any of the medications you take raise your risk for gangrene. 4
Diagnosis A health care provider can diagnose gangrene in several ways. Blood tests may be used to check for signs of an infection. Imaging tests can look at areas inside the body to see if gangrene is present and if it has spread. Some examples of imaging tests are x-rays, MRIs and CT scans. An MRI uses radio waves and a powerful magnet linked to a computer to create detailed pictures of areas inside the body. These pictures can show the difference between normal and abnormal tissue. A CT scan uses a computer linked to an x-ray machine to take detailed pictures of areas inside the body from different angles. An arteriogram may be used to check blood flow in the arteries. During this test, dye is injected into the bloodstream and x-ray pictures are taken to see how well the blood moves. This test helps your health care provider find blocked arteries, which could cause gangrene. A tissue culture may be used to look for signs of infection. Fluid may also be taken from a blister on your skin and examined for the bacterium Clostridium. Sometimes surgery is used to determine how far gangrene has spread within the body. Arteriogram Treatment There is no treatment to reverse the damage caused by gangrene. The tissue cannot be saved. Instead, the goal of treatment is to prevent the spread of gangrene. This section reviews the different treatment methods most commonly used to stop gangrene from affecting other tissues in the body. Surgery is often used to remove dead tissue. This prevents gangrene from spreading and allows healthy tissue to heal. If possible, a surgeon will also repair damaged or diseased blood vessels. This can increase blood flow to the affected area. Reconstructive surgery may be used to replace damaged skin. Healthy skin is taken from another part of your body, usually a place hidden by clothing. This healthy skin is carefully spread over the affected area. It is held in place by a dressing or by a few small stitches until it heals. 5
Sometimes the removal of an affected body part is necessary to prevent the spread of gangrene. This is known as an amputation. It is used only in severe cases of gangrene. Amputation is most often used to remove a toe, finger, arm or leg. It can also remove a gall bladder, appendix or segment of intestine affected by gangrene. Medicine may be used to treat an infection caused by gangrene. Intravenous antibiotics are special drugs used to fight off harmful bacteria. Intravenous, or IV, refers to a way of giving a drug through a needle or tube inserted into a vein. They are usually given if your health care provider prescribes antibiotics, it is important that you take them exactly as prescribed until all of the medication is gone. Oxygen can also be used to treat certain types of gangrene. Hyperbaric oxygen therapy may be an effective treatment for gas gangrene. It provides a higher than normal level of oxygen to the body, which helps slow the growth of certain bacteria. It also helps infected wounds heal more easily. In hyperbaric oxygen therapy, you are placed in a Hyperbaric Oxygen Therapy special chamber that is pressurized with pure oxygen. You may spend about 90 minutes in the chamber up to three times in one day. This may be followed by twice-daily treatments for up to five days. Prevention You may be able to reduce your risk for developing gangrene. If you have diabetes, you should regularly examine your body for injury. Check for cuts on your hands and feet daily. Also looks for sores and signs of infection, such as redness, swelling or drainage. Finding and treating wounds early can help prevent complications. If you are overweight, create a diet or exercise plan to help you lose weight. Extra pounds increase your risk for diabetes and damage your arteries. This restricts blood flow and puts you at risk for infection and slow wound healing. Always talk with a healthcare provider before starting a new diet or exercise program. If you smoke or use other tobacco products, quit. Using tobacco products damages your blood vessels. If blood stops flowing to the areas that need it, you may develop gangrene. 6
Avoid prolonged exposure to cold temperatures. Frostbite can lead to gangrene because it reduces blood circulation to the affected area. If you notice that an area of skin has become pale, hard, cold and numb after being exposed to the cold, call a health care provider. Summary Gangrene is the death of tissues in your body. There are two major types: Dry gangrene, caused by a lack of blood flow to an area of the body. Wet gangrene, caused by a bacterial infection. Gangrene can happen on the surface of the body, such as on the skin. It can happen inside the body in muscles or organs. Symptoms differ depending on what caused it and where it is located. Symptoms may include discolored skin, swelling and pain in the affected area, foul-smelling discharge, fever and other problems. Treatment is meant to stop the spread of gangrene. Surgery, amputation, antibiotics and hyperbaric oxygen therapy may be used. A skin graft can help cover a visible area of the body that has been damaged by gangrene. Gangrene can be prevented by taking care of your body. Maintaining a healthy weight, quitting smoking, controlling health problems like diabetes and avoiding extremely cold temperatures are some of the ways gangrene can be prevented. 7