Gangrene

1 What is Gangrene?

Gangerene is also referred to the death of body tissue as a result of the lack of flow of blood or bacterial infection. It often occurs in the body extremities such as the toes, fingers, and limbs.

It also occurs in the muscles and internal organs of the body. The risk for gangrene is high in conditions where the exposure to damage of the blood vessels and that it may affect the flow of blood is high.

This is common in conditions such as diabetes, and atherosclerosis. The main management strategy for gangrene is by surgical removal of the dead tissue, administration of antibiotics, and other modes of treatment.

The main prognosis for recovery is an earlier identification of gangrene for early treatment.

2 Symptoms

The symptoms of gangrene vary depending on the underlying cause. It can affect any part of the body, but typically starts in the toes, feet, fingers or hands.

When gangrene affects your skin, it leads to skin discoloration to a variety of color ranging from pale, blue, purple, black, bronze, red and any other color. The color varies with the type of gangrene which denotes a clear line between being healthy and infected with gangrene.

It is characterized by severe pain, numbness of the extremities, a foul smelling discharge, leaking from a sore. When affected by a type of gangrene that affects tissues beneath the surface such as gas gangrene, or internal gangrene, the affected parts will often be swollen, and painful.

You will also learn that you have a fever and a feeling of being unwell. A condition referred to as septic shock may also occur when the bacterial infection originating from the gangrenous tissues spreads throughout the body.

Septic shock is characterized by low blood pressure, fever, rapid heartbeat, lightheadedness, shortness of breath, confusion.

Gangrene is a very serious condition and one is required to see a doctor as quick as possible, immediate treatment is required for this condition.

In case of persistent and unexplained pain in any part of the body with the following symptoms:

  • persistent fever,
  • skin changes with discoloration,
  • warmth,
  • swelling,
  • blisters,
  • lesions that don’t heal,
  • a foul smell,
  • leaking sores,
  • sudden pain at the site of injury,
  • the extremities may be hard,
  • cold and numb.

3 Causes

Gangrene may be caused by the following:

Lack or poor blood supply to the body tissues,blood ensure that nutrients,oxygen and immune system such as antibodies so as infections can also be fought.

The absence of blood supply ensures that the cells won’t survive and that the body tissues will be able to decay. In the case of infections, when the bacteria thrive and are unchecked for longer durations, they can take over the body tissues and cause gangrene.

There are several types of gangrene:

  • Dry gangrene which is characterized by a dry and shriveled skin, the color may vary from brown to purple-black. It also develops slowly and occurs often in people with the disease of the blood vessels such as diabetes and atherosclerosis.
  • Wet gangrene is associated with a bacterial infection of the tissues. It causes the swelling, blistering and wetness of the region affected. It may come after a severe burn, frostbite or severe injury to a tissue. It also occurs in people with severe diabetes and that unknowingly get injured on the toe or foot. It also requires that it is treated quickly since it can be very fatal.
  • Gas gangrene: affects the deep muscle tissues. The surface of the skin may appear normal, and change over time with a severity of the infection to pale and eventually change to gray or purple in color. The skin may also become bubbled around the affected region. It will often make a crackling sound when you press on it as a result of the gas within the tissue. Gas gangrene is caused by an infection of bacterium clostridium perfringens. It often develops after an injury or surgical wound which lacks sufficient blood supply. The bacterial infection often produces toxins that produce a gas and therefore the name, gas gangrene, the gas can cause cell and tissue death. Just like the wet gangrene, gas gangrene is also life threatening.
  • Another form of gangrene is the internal gangrene which affects one or more of the body organs: small intestines, gallbladders, appendix etc. This often occurs when the blood flow to the internal organs is minimal of completely blocked. These may lead to bulging of the intestines in the weakened regions of the muscles of the abdomen also referred to a hernia, and eventually become twisted. Internal gangrene comes with fever and pain. When untreated, it can be fatal.
  • Fournier’s gangrene involves the infection of the genital organs. The prevalence of men with Fournier’s gangrene is higher than in women, and may arise as a result of the infection of the genital areas or urinary tract and lead to genital pain. It is also associated with tenderness, redness and swelling.
  • Finally, Meleney’s gangrene is as a result of the progressive bacterial synergistic gangrene. This is a rare type of gangrene and may occur often after an operation, it comes with painful lesions, developing one to two weeks after surgery.

4 Making a Diagnosis

Making a diagnosis of gangrene is done by performing several tests.

In case you suspect that you have gangrene, call your doctor. Call your doctor right away if you have symptoms of gangrene. This may vary with the severity of your symptoms.

You may be advised to report to the emergency department of a medical facility. Be prepared for a medical evaluation. Take note of the symptoms you are experiencing and the duration it has lasted.

This will offer doctors an insight into the possibility of your symptoms and how they have progressed over time since your first symptoms and how they have worsened over the time.

Any form of injury you have had in the recent past also needs to be noted such as cuts, bites, injections, surgery and or frostbites.

Any recent disease diagnosis also needs to be indicated. Medications used in the form of supplements, vitamins, and any other form of a drug.

Always take a family member with you along for any appointment with the doctor. They may also be of help in case one needs immediate treatment. Questions to ask the doctor on your visit can also be noted down.

Doctor may also ask you a few questions such as:

  • When did your symptom first start?
  • Are you feeling any form of pain?
  • Is the disease spreading or getting worse?
  • Do you have any recent injuries or bites?
  • Have you been exposed to the cold in the recent past?
  • Was the disease diagnosed?
  • What medication have you used in the recent past? 

Some of the test to be done include: 

Blood tests which are characterized by an elevated white blood cell count which may be an indication of the presence of an infection. 

The imaging test can also be done such as X-rays or computerized tomography (CT) scan, Magnetic resonance imaging (MRI), are used to observe the internal body structures and to also assess the extent of gangrene.

An arteriogram is also an imaging test which can be used to visualize the blood arteries.

A dye is injected into the blood stream and X-rays pictures to show how well the blood can flow through the blood arteries. This will determine if the arteries are blocked.

Surgery may also be used to determine the extent of the spread of gangrene in your body. Tissue and fluid culture can also be performed for examination for the presence of bacterium; Clostridium perfringens, which is a common cause of gas gangrene.

The tissue samples can also be observed using a microscope for signs of cell death.

5 Treatment

Treatment for gangrene involves removing the affected tissue, preventing or treating any existing infection, and treating the problem that led to gangrene developing.

Tissues damaged by gangrene cannot be saved. There are several ways that can be done to prevent gangrene from processing. Some of the management strategies include surgery.

This enables the doctors to remove some of the tissues that help stop gangrene which stops the spread of gangrene and allows the tissues to heal. The doctor can also repair the damaged or diseased blood vessels so as to increase blood flow to the regions that are affected.

A skin graft can also be used for a type of reconstructive surgery which may be used for the repair of damaged tissues. During this processes, a doctor removes a healthy skin from another part of your body at a region that is hidden by clothing and can be spread over a region of the body that is affected. It is held by a small number of stitches.  

A skin graft will only be able to work when the blood supply is restored. In cases of severe gangrene, the affected part of the body can be surgically removed, amputated. However, an artificial limb can be fitted (prosthesis).

Antibiotics can be given through the vein (IV) as a way of managing gangrene when infected.

Hyperbaric oxygen therapy can also be used in the management of gangrene. Under increase blood pressure, and high oxygen content, your blood is able to carry high amounts of oxygen. It is known that blood rich in oxygen slows the growth of bacteria that thrive in the absence of oxygen. This helps with the healing of the healing of the infected wounds. The patient is placed in an oxygen chamber and usually be managed for about 90 minutes. This may be repeated 2 or 3 times every day.

Supportive care may also be used with either nutrients and fluids or both and combined with painkillers. People with dry gangrene have full potential to recover since it does not involve bacterial infections. Its rate of spread is also very slow compared to other types of gangrene. However, when gangrene caused by an infection is treated quickly, the potential for recovery is good.

6 Prevention

Gangrene can be prevented by:

  • Proper management of diabetes with frequent monitoring and management.
  • Monitoring for the cuts, sores and infections by monitoring the redness, swelling, and drainage.
  • Performing medical examination one in a year.
  • Weight loss to lower the risk of developing diabetes, and pressure on arteries by constricting of the blood flow. 

Diabetes places you at risk for infection and slow wound healing. Do not smoke tobacco since it causes damage to your blood vessels. Reduce infections by washing open wounds with soap and clean water to enable the wounds to dry and heal.

Rapid changes in temperature should also be avoided. Frostbitten skin may lead to development gangrene. Frostbite leads to gangrene since it promotes reduced blood circulation in the affected areas.

Paling of the skin, hardness, cold and numbness after exposure to cold temperatures, inform your doctor.

7 Risks and Complications

There are several factors that increase the risk of developing gangrene.

  • Diabetes is associated with low insulin production, a key hormone that promotes intake of blood sugar by the cells. It also promotes resistance to the effects of insulin. Both of this conditions leads to high blood sugar which cause damage to the blood vessels, interrupting the blood flow to parts of the body. Disease of the blood vessels also leads to hardened and narrowed arteries (atherosclerosis) and formation of blood clots which stops blood flow to some parts of the body.
  • Injury or surgery also affects the skin and tissues beneath them through bites, frostbites or surgery leading to gangrene. This condition is worsened when blood flow to the injured region is affected.
  • Smoking increases the risk of gangrene. Obesity is often observed in diabetes and vascular diseases. The extra weight also exerts pressure to the arteries leading to the reduction in the blood flow and increasing the risk of infection and poor wound healing.
  • Immunosuppression caused by certain diseases such as human immunodeficiency virus (HIV) or you are and chemotherapy or radiology treatment lowers the body ability to protect itself from infection.
  • Medication such as the anticoagulant drug (Warfarin) also causes gangrene. This occurs especially when used in combination with heparin therapy.

Gangrene causes the scarring of the skin and therefore, the need for reconstructive surgery. Tissue damage can be very extensive leading to the amputation of your limb. Wet gangrene spread to other parts of the organs and will be fatal when left untreated.

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