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Gangrene involves tissue death of a part of the body. It can involve any part of the body, including the skin, muscles, bone and blood vessels. It can involve the extremities, the abdominal structures and other body structures.
The cause of gangrene is the lack of blood supply to a part of the body. It can happen secondary to a bacterial infection, an injury to a body part or to another reason, such as atherosclerosis of a blood vessel leading to a body part. You are at risk for gangrene if you have an injury to a body area, such as a leg or arm, atherosclerosis of a body area, including the abdominal arteries and extremity arteries, diabetes, previous surgery or a decreased immune system.
The symptoms of gangrene depend on where you have the lack of blood supply. The skin is often blue or black. If the area just beneath the skin is involved, the skin can look bronze or red in colour. There may be open sores with a foul discharge and a loss of the ability to feel anything, which may follow a period of time when it is extremely painful. Other symptoms include fever, confusion, gas in the tissues under the skin (in gas gangrene), general feeling of being ill, severe or persistent pain or low blood pressure.
Doctors may be able to diagnose gas gangrene or regular gangrene just by a physical exam and history alone. There are tests and procedures to help define the condition, including an arteriogram, which outlines the flow of blood through the arteries and which is abnormal in gangrenous situations; blood tests can show a high white blood cell count; a CT exam can check on the integrity of the internal organs; a culture from the wounds can show infection with certain bacteria; you can do a biopsy to see if there are dead cells in the tissue. Other x-rays may be helpful to show gas in the tissues.
The treatment of gangrene needs to be prompt so the gangrene doesn't cause more tissue death or secondary organ failure due to toxins in the blood from the bacteria that are causing the gangrene. Depending on how sick the person is and on which body areas are involved, the treatment may actually involve amputation of the body part that is affected by gangrene. The surgery done usually needs to be done urgently and the dead tissue needs to be removed completely. Antibiotics can kill the infectious organisms involved in gangrene and there is a likelihood of repeated surgeries to continue to de-bride tissue that is dead after the original treatment. Much of the treatment involves care in the intensive care unit, particularly for patients who are severely ill.
The prognosis of gangrene depends on which body area is affected and how severely it is affected. The prognosis is better when distal extremities are affected than if the GI tract is affected. If treatment is not promptly performed on any are of gangrene, death may ensue.
Complications of gangrene include significant disability secondary to amputation or removal of the dead tissue in the body. The healing of a gangrenous area, even after surgery, can be prolonged and things like skin grafting may be necessary to make sure the wound heals properly. As mentioned, gangrene can result in death if it is not treated promptly.
Prevention of gangrene includes having your injuries treated as soon as possible so the cause of the gangrene can be addressed. The prevention of gangrene can mean careful treatment of the damaged blood vessels and antibiotics to address the bacteria that are the underlying cause of gangrene. Doctors must watch carefully for drainage, swelling, redness or any type of failure to heal. Diabetics need to watch the circulation of their feet regularly and to make sure they watch any injuries of the feet. If there is a change in color or feeling of the toes or feet, a doctor should be notified.
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