What is Gangrene?
Gangrene is caused by infection or loss of blood flow to a part of the body. The tissue begins to “die off” and turn into black eschar (Scabbing). If not treated promptly with a course of antibiotics and proper wound care, the body part will need to be amputated. This condition is common in diabetics that suffer from a condition known as peripheral vascular disease; this happens when high blood sugars damage the tiny blood vessels to the feet and legs. (See Figure 1)
This condition is very serious and many fatalities have resulted from untreated gangrene. The infection and toxins from the tissue die off can enter the bloodstream and cause the entire body to become infected (sepsis).
Gangrene is more common the small the areas of the body, but rarely can affect larger parts of the body. The tips of the fingers, the small toes, ears and even the nose are most commonly affected. This is due to a very small amount of blood supply to the tissues.
Figure 1: Gangrene of the Foot/Toes
Courtesy of Umm.edu
What are the types of Gangrene?
- Dry – The mildest form and the easiest to treat. Mainly just dry dead tissue on the outside of a wound.
- Wet – This type is moderately severe. Wet gangrene is characterized by drainage from the wound and the appearance of “wet” tissue. It is most common in diabetics.
- Internal – This form happens when an organ loses circulation. A common kind is gangrene of the gallbladder due to severe gallbladder disease.
- Gas – Most often caused by surgery that has caused bacteria to become trapped within the body. There are no apparent signs of infection on the outside, but it is evident by swelling and a bubble sound when the swelling is depressed.
Causes of Gangrene
This condition can happen to anyone, but is more common in anyone with higher risk factors. The first cause of gangrene is a lack of blood supply to the tissues. In anyone, this can happen with frostbite, constriction of the body part or injury. Those with the highest risk of this occurring are people with diseases that affect blood supply including; diabetics with diabetic neuropathy (Inability to feel injuries in the feet and legs), and People with peripheral vascular disease.
The second factor in gangrene is infection to the body part. This happens most often when a diabetic cannot feel an injury to the foot, which goes untreated and quickly turns into gangrene. A healthy person could get frostbite to the toes and infection can set in, which can lead to gangrene. Any other person with immune system issues or chronic health conditions can be susceptible to gangrene.
Being overweight can also raise the risk of this condition. Extra weight can cause constriction of blood vessels and weaken blood supply to parts of the body. People of advanced age over 50 are also more susceptible to gangrene, even without any health conditions. As the blood vessels age, they leave the tissues more prone to infection.
What are the symptoms of Gangrene?
When gangrene sets in there may only be the appearance of a scab over injured tissue. The difference is the scab is usually black. This is referred to as eschar. If the infection is not treated promptly, the symptoms become more prominent including:
- Redness around the area of the wound (erythema)
- Drainage that has an odor; may be yellow, green or tan
- Throbbing pain; diabetics may or may not feel any pain
- Swelling to the area and extending up the extremity
- Pale skin (when frostbite has occurred)
- Fever (If the infection has gone into the bloodstream)
- Shortness of breath, confusion and low-blood pressure
When anyone experiences the above bold symptoms, the infection has already become serious. The patient usually needs to be hospitalized immediately. It is extremely important for families and caregivers of diabetics, people with poor circulation and chronic health conditions to understand the symptoms of gangrene. This will help reduce or prevent serious complications such as; amputation of a limb, other surgery or death.
How is Gangrene treated?
The treatment for mild gangrene can be managed with proper wound care and oral antibiotics. The wound will be cultured for the bacteria and find which antibiotic will work best to treat the infection. A wound specialist can take off the areas of diseased tissue and give daily wound care until the patient has healed.
Moderately severe cases will need to be treated with intravenous antibiotics either at home or in a hospital. A surgeon may take the patient into surgery and surgically remove (debride) the diseased tissue. A wound specialist will then perform daily wound care until it has healed. If the surgeon has to remove too much tissue, a skin graft may be performed to replace lost tissue. Often, the body will fill in the area on its own with the right wound care.
Severe gangrene must be treated with intravenous antibiotics in the hospital and if sepsis has occurred then the patient will be placed in the intensive care unit. The physician may try to place the patient in an oxygen chamber to increase the oxygen to the wound site and aid healing. Surgical debridement may be attempted, but usually not until the patient has stabilized. With sepsis, the patient will have unstable vital signs and often is not a candidate for surgery. Once the patient is stable, surgical removal of the disease tissue is attempted but often the surgeon may need to perform an amputation when the condition is very severe.
(See Figure 2)
Figure 2: Amputation of a Foot with Gangrene
Courtesy of Patientedlibrary.co
Gangrene is a very serious and severe form of infection in the tissue. If it is left untreated; it can lead to internal infection of deeper tissues, sepsis in the blood, amputation of a body part and in some circumstances death.
Anyone with symptoms of gangrene in a wound or possible frostbite should seek medical care immediately to avoid complications.