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Gangrene

Definition


Disease: Gangrene Gangrene
Category: Other Diseases

Disease Definition:

When the blood flow to a certain area of the body is interrupted it will result in the decay and death of tissue, a condition called gangrene. A bacterial infection is also involved in some types of gangrene. Although gangrene could occur in muscles and internal organs, but it usually affects the extremities, including toes, fingers and limbs.

 

In case someone has diabetes or atherosclerosis, which are conditions that could damage blood vessels and impede blood flow, the chances of developing gangrene will be higher.

 

Antibiotics and surgery to remove dead tissue are some of the treatments for gangrene, along with other approaches. When gangrene is identified early and treated quickly, the prognosis for recovery is quite good.

 

Work Group:


Symptoms, Causes

Symptoms:

In case gangrene affects the skin, these will be some of the signs and symptoms:

 

  • A blue or black discoloration of the skin
  • A foul-smelling discharge leaking from a sore
  • Severe pain followed by a feeling of numbness

 

In case gangrene affects the tissues beneath the surface of the skin, including gas gangrene or internal gangrene, these will be some of the signs and symptoms:

 

  • Fever and a general feeling of being unwell
  • The affected tissue will be painful and swollen.

 

In case a bacterial infection that originated in the gangrenous tissue spreads throughout the body, a condition called septic shock could occur, which may show these signs and symptoms:

 

  • Shortness of breath
  • Rapid heart rate
  • Lightheadedness
  • Confusion
  • Low blood pressure

 

Gangrene needs immediate treatment because it's a serious condition. So, if someone has persistent unexplained pain in any area of their body as well as one or more of these symptoms, they should immediately see a doctor:

 

  • Recurring sores or a wound that's slow to heal
  • Skin that has become hard, pale, cold and numb, which could be an indication of frostbite.
  • Persistent fever
  • A foul smelling discharge leaking from a sore
     

Causes:

When a body part, such as the skin, muscle or even an organ loses it blood supply, gangrene occurs. Blood feeds tissues by providing oxygen, nutrients in order to feed cells, and immune system components, such as antibodies, in order to ward off infections. However, the cells cannot survive without a proper blood supply.

 

Blood flow is affected by an injury, an underlying condition or a combination of the two; this could cause gangrene

 

Listed below are some of the types of gangrene:

Wet gangrene:

In case there's a bacterial infection in the affected tissue, gangrene is referred to as "wet". Some of the characteristics of wet gangrene include swelling, blistering and a wet appearance. A severe burn, frostbite or injury could cause this type of gangrene, but it usually occurs in people who have diabetes and accidentally injure a foot or toe. Wet gangrene spreads quickly and could be fatal, thus, it needs immediate treatment.

Dry gangrene:

A dry and shriveled skin that ranges in color from brown to purplish-blue to black is one of the common features of dry gangrene. Dry gangrene usually develops slowly and occurs in people with atherosclerosis, which is a blood vessel disease.

Fournier's gangrene:

An uncommon type of gangrene that involves the genital organs is called Fournier's gangrene. Despite the fact that women could develop this type of gangrene, however, men are affected with it more often. Usually, an infection in the genital area or urinary tract could result in this type of gangrene and cause redness, swelling, genital pain and tenderness.

Internal gangrene:

This type of gangrene affects one or more of the organs, most commonly the intestines, gallbladder or appendix. For instance when the intestines bulge through a weakened area of muscle in the abdomen (hernia) and become twisted making blood flow to it blocked, this kind of gangrene occurs. Fever and severe pain are some of the symptoms of internal gangrene. This type could become fatal in case it's left untreated.

Gas gangrene:

Generally, gas gangrene affects deep muscle tissue. If someone has gas gangrene, the surface of their skin could appear normal at first, however, as the condition progresses, it could turn pale and then evolve to a gray or purplish-red color. Because of the gas within the tissue, the affected skin might make a crackling sound when pressed on it, along with the bubbly appearance of the skin.
In most cases, gangrene is due to an infection with the bacteria Clostridium perfringens which develops in an injury or surgical wound that's depleted of blood supply. Toxins are produced by the bacterial infection which release gas, hence the name "gas" gangrene, and cause death of tissue. Gas gangrene could become life-threatening just like wet gangrene.

 

Complications

Complications:

Gangrene could cause either scarring or the need for reconstructive surgery.  In some cases, a body part may need to be removed, such as the foot in case tissue death in that part of the body is so extensive.

 

If left untreated, gangrene could be fatal, particularly if it's infected with bacteria because it could quickly spread to other organs of the body.
 

Treatments:

Even though steps could be taken to prevent gangrene from progressing, however, the tissue that has been damaged by gangrene cannot be saved. Some of these treatments are:

 

ANTIBIOTICS:

When gangrene has become infected, it could be treated with intravenous antibiotics.

 

SURGERY:

In surgery, the dead tissue will be removed, which will help stop gangrene from spreading and allow healthy tissue to heal. In order to increase blood flow to the affected area, the damaged or diseased blood vessels will be repaired if it's possible.

 

In case the gangrene has caused extensive damage to the skin, a type of reconstructive surgery called a skin graft could be used, during which healthy skin will be removed from another part of the body, usually a place that is hidden by clothing, and it will be carefully spread over the affected area. A dressing or a couple of small stitches could hold the healthy skin in place. The only time when skin graft can be done is when an adequate blood supply has been restored to the damaged skin.

 

An affected body part, such as a toe, finger or limb, may need to be amputated in some severe cases of gangrene. And sometimes, a person may be fitted with an artificial limb (prosthesis).

 

HYPERBARIC OXYGEN THERAPY:

Gas gangrene could be treated with hyperbaric oxygen therapy. The patient will be placed in a special chamber in this therapy consisting of a padded table that slides into a clear plastic tube. This chamber is pressurized with pure oxygen. Inside the chamber, the pressure will slowly rise to about two and a half times more than the normal atmospheric pressure. Under increased oxygen content and pressure, blood will be able to carry greater amounts of oxygen. The growth of bacteria that thrive in the absence of oxygen is inhibited by blood rich in oxygen, and the infected wounds are healed more easily.
Usually, treatment of gas gangrene with hyperbaric oxygen therapy lasts about 90 minutes. On the first day of treatment, the patient may need up to three treatments, and for the next five days, twice-daily treatments. The patient's ears may pop during the therapy as they adjust to the increased pressure. The patient might feel tired and lightheaded after the therapy session.

 

Lots of fluids, nutrients and pain medications to relieve discomfort are some of the other treatments for gangrene, along with other supportive care.
 

Prognosis:

Because dry gangrene doesn't involve a bacterial infection and spreads more slowly than do other types of gangrene, generally, people with dry gangrene have the best prognosis. Nevertheless, the probability of recovery is quite good in case the infected gangrene is recognized and treated quickly.

 

People who have underlying conditions, such as diabetes, atherosclerosis or some cancers, those who have advanced cases of gangrene along with old people who are immunocompromised will probably have complications from gangrene by the time they seek treatment.

 

Expert's opinion

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