by Carson-DeWitt R

Gangrene

(Dry Gangrene; Gas Gangrene; Organ or Tissue Death; Wet Gangrene)

Definition

Gangrene is the progressive death of body tissue resulting from infection and a lack of blood supply. When the blood supply is cut off, the tissue does not get enough oxygen and begins to die.
Gangrene can be internal or external. The 2 most common types of gangrene are:
  • Dry gangrene—Lack of blood supply causes the tissue to die.
  • Wet gangrene—Usually occurs when the tissue is infected with bacteria from an injury. The tissue becomes moist and breaks down.
A rare wet type, called gas gangrene or clostridial myonecrosis, develops from specific bacteria deep inside the body. Gas gangrene can be a result of surgery or trauma.

Causes

Gangrene is caused by infection or a reduced blood supply to tissues.

Risk Factors

Gangrene is more common in older adults.
Other factors that may increase your chance of gangrene include:
  • Poorly controlled health conditions, such as diabetes or atherosclerosis, which may affect blood vessels
  • Health conditions or medications that suppress the immune system
  • Perforated bowel
  • Severe trauma
  • Surgery
  • Smoking
  • Obesity
  • Excessive alcohol use
  • IV drug use

Symptoms

External gangrene may cause:
  • Color changes, ranging from white, to red, to black
  • Shiny appearance to skin
  • Foul-smelling, frothy, clear, or watery discharge
  • Shedding off of skin
  • Severe pain followed by loss of feeling in the affected area
Internal gangrene may cause:
  • Fever and chills
  • Confusion
  • Nausea and vomiting
  • Diarrhea
  • Lightheadedness or fainting, which may be caused by low blood pressure
If the gangrene is widespread, sepsis can occur.
Gangrene of the Foot
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Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
  • Blood tests
  • Tests of the discharge and the tissue
Images may be taken of your bodily structures. This can be done with:

Treatment

Treatment of gangrene includes:
  • IV antibiotics—to treat infection
  • Debridement—surgical procedure to cut away dead and dying tissue, done to try to avoid gangrene from spreading
  • Supportive care, including fluids, nutrients, and pain medication to relieve discomfort
  • Blood thinners—given to prevent blood clots
  • Surgery may also be done to restore blood flow to the affected area
  • Amputation—removal of severely affected body part
  • Hyperbaric oxygen treatment—exposing the affected tissue to oxygen at high pressure may have some benefit

Prevention

To help reduce your chance of gangrene:
  • If you have chronic health conditions, follow the treatment plan outlined by your doctor.
  • If you have diabetes, inspect your feet every day for cuts, sores, or wounds.
  • Care for any cuts, sores, or wounds promptly to avoid infection.
  • If you need surgery, ask your doctor about taking antibiotics. This is especially true if you need intestinal surgery.

RESOURCES

American Diabetes Association
http://www.diabetes.org
Family Doctor—American Academy of Family Physicians
http://www.familydoctor.org

CANADIAN RESOURCES

Canadian Diabetes Association
http://www.diabetes.ca
Health Canada
http://www.hc-sc.gc.ca

References

A quick summary of the 6 types of necrosis. Pathology Student website. Available at: http://www.pathologystudent.com/?p=5770. Accessed August 5, 2015.
Clostridial myonecrosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 1, 2014. Accessed August 5, 2015.
Fujiwara Y, Kishida K, Terao M, et al. Beneficial effects of foot care nursing for people with diabetes mellitus: an uncontrolled before and after intervention study. J Adv Nurs. 2011;67(9):1952-1962.
Gangrene. NHS Choices website. Available at: http://www.nhs.uk/Conditions/Gangrene/Pages/Introduction.aspx. Updated January 27, 2014. Accessed August 5, 2015.
Sepsis in adults. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 25, 2014. Accessed September 29, 2014.

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