gangrene in adults

Gangrene means the death of body tissue due to lack of blood flow or a serious bacterial infection. The pathology usually affects the extremities, including the toes, fingers, and parts of the body above the fingers, but can also occur in the muscles and internal organs.

What is gangrene

The chances of developing gangrene are higher if the person has an underlying serious condition that can damage relatively small blood vessels and affect blood flow, such as diabetes mellitus or damaged arteries from atherosclerosis. Treatment for gangrene includes surgery to remove dead tissue, antibiotics, and hyperbaric oxygen therapy. The prognosis for recovery is better if gangrene is detected early and treated quickly.

Causes of gangrene in adults

Gangrene can occur for one or more of the following reasons:

Lack of blood supply. The circulation of blood through the vessels provides oxygen, nutrients to keep cells active, and components of the immune system, such as antibodies, to prevent infections. Without a proper blood supply, cells cannot survive, and damaged, oxygen-deprived tissue decays.

Infection. If the bacteria live and multiply uncontrollably in the tissues for a long time, the infection can take over and lead to tissue death, causing gangrene.

Injury. Traumatic injuries, such as gunshot wounds or serious injuries from car accidents, can cause bacteria to invade tissues deep within the body. When these tissues become infected, gangrene can occur.

Types of gangrene

Dry gangrene. Dry gangrene is characterized by dry and wrinkled skin that ranges in color from brown to purplish blue or black. Dry gangrene can develop slowly. It is most common in people with arterial blood vessel diseases such as atherosclerosis or in people who have diabetes.

Wet gangrene. Gangrene is called “wet” if there is a bacterial infection in the affected tissue. Swelling, blistering, and a wet appearance are common features of wet gangrene. It can develop after a severe burn, frostbite or injury. This often occurs in people with diabetes who unknowingly injure a toe or foot. Wet gangrene must be treated immediately because it spreads quickly and can be fatal.

Gas gangrene. Gas gangrene usually affects deep muscle tissues. If gas gangrene develops, the surface of the affected skin may initially appear normal. As the condition progresses, the skin may turn pale and then turn gray or purplish red. Blisters may appear on the skin, and the affected skin may make a crackling sound when pressed due to the presence of gas in the tissues. Gas gangrene is most often caused by the bacterium Clostridium perfringens, which develops when there is an injury or surgical wound where the blood supply is depleted. The bacterial infection produces toxins that release gas, hence the name “gas” gangrene. These processes cause tissue death. Like wet gangrene, gas gangrene can be life-threatening.

internal gangrene. Gangrene that affects one or more internal organs, such as the intestines, gallbladder, or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked—for example, when the intestines bulge through a weakened area of ​​muscle in the abdomen (hernia) and twist. Internal gangrene can cause fever and severe pain. Left untreated, internal gangrene can be fatal.

Fournier’s gangrene. Fournier’s gangrene affects the genitals. Men are more commonly affected, but women can also develop this type of gangrene. Fournier’s gangrene usually occurs due to an infection in the genital or urinary tract and causes discomfort, soreness, redness, and swelling of the genitals.

Progressive bacterial synergistic gangrene (Meleney’s gangrene). This rare type of gangrene usually occurs after surgery, when painful skin lesions develop 1 to 2 weeks after surgery.

Risk Factors

Several factors increase the risk of developing gangrene. This includes:

Diabetes. If a person has diabetes, their body does not produce enough of the hormone insulin (which helps cells metabolize blood sugar) or is resistant to the action of insulin. High blood sugar can eventually damage blood vessels, reducing or cutting off blood flow to any part of the body (usually the skin on the extremities).

Disease of the blood vessels. Hardened and narrowed arteries (atherosclerosis) and blood clots (clots) can also block blood flow to a specific area of ​​the body.

Severe injury or surgery. Any process that causes trauma to the surface of the skin and underlying tissues, including burns or frostbite, increases the risk of developing gangrene. Especially if the person has an underlying condition that affects blood flow to the injured area.

Smoking. Smokers have an increased risk of gangrene.

Obesity. Obesity often accompanies diabetes and vascular disease, but the stress associated with being overweight can also compress arteries, resulting in reduced blood flow and increased risk of infection and poor wound healing.

Immunosuppression. If a person has the human immunodeficiency virus (HIV) or is undergoing chemotherapy or radiation therapy, the body’s ability to fight infection is impaired.

Medications or preparations that are given by injection. In rare cases, injected drugs and illegal drugs have been shown to cause infection with gangrene-causing bacteria.

Symptoms of gangrene in adults

When gangrene affects the skin, signs and symptoms may include:

• change in skin color – from pale to blue, purple, black, bronze or red, depending on the type of gangrene in the patient;
• swelling of the skin or the formation of fluid-filled blisters on it;
• a clear line between healthy and damaged skin;
• sudden severe pain followed by a feeling of numbness;
• discharge from wounds with an unpleasant odor, fluid flowing from an ulcer;
• thin, shiny skin or skin without hair;
• skin that feels cool or cold to the touch.

If a type of gangrene develops that affects tissues under the surface of the skin, such as gas gangrene or internal gangrene, you may notice that:

• the affected tissue is swollen and very painful;
• a person has subfebrile temperature and feels unwell.

A condition called septic shock can occur when a bacterial infection that originates in gangrenous tissue spreads throughout the body.

Signs and symptoms of septic shock include:

• low blood pressure
• possibly fever, although the temperature can also drop below normal (36 ° C);
• cardiopalmus;
• violation of brain activity;
• dyspnea;
• confusion of consciousness.

Treatment of gangrene in adults

Call your doctor right away if you have symptoms of gangrene. Depending on the severity of the symptoms, the patient may be asked to go to the emergency room or surgical department for medical attention.

Diagnostics

Tests used to diagnose gangrene include:

Blood tests. An abnormally high white blood cell count often indicates an infection. The doctor may also do a blood test to check for the presence of certain bacteria or other pathogens.

visual tests. X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to view internal structures in the body, such as internal organs, blood vessels, or bones, and assess the extent of gangrene. These types of tests can also help the doctor detect any gas that is present under the skin.

Arteriogramis an imaging test used to evaluate the structure of the arteries. During this test, a dye is injected into the bloodstream and X-rays are taken to determine how well the blood is flowing through the arteries. An arteriogram can help your doctor find out if any of your arteries are blocked.

Operation. Surgery may be done to determine how much gangrene has spread throughout your body.

Liquid or tissue culture. A culture of fluid from a skin blister may be examined for the presence of the bacterium Clostridium perfringens, a common cause of gas gangrene, or a doctor may look at a tissue sample under a microscope for signs of cell death.

Modern treatments

Tissue damaged by gangrene cannot be saved, but steps can be taken to prevent gangrene from progressing. Depending on the severity of the gangrene, a doctor may choose one or more of these treatment options.

Operation. A specialist may perform a surgical procedure to remove dead tissue, which helps stop the spread of gangrene and allows healthy tissue to heal. If possible, a doctor can repair damaged or diseased blood vessels to increase blood flow to the affected area. Sometimes more than one operation may be required to remove all dead or infected tissue.

If reconstructive surgery is needed, the surgeon may use a skin graft to repair skin damage caused by gangrene. During a skin graft, a doctor removes healthy skin from another part of the body—usually a place hidden by clothing—and gently spreads it over the affected area. Healthy skin can be held in place with a bandage or a couple of small stitches. A skin graft can only be applied if an adequate blood supply has been restored to the damaged skin.

Antibiotics. Antibiotics that are given through a vein (intravenously) or those taken by mouth can be used to treat infected gangrene. If surgery is due to remove dead tissue, the doctor will likely prescribe certain antibiotics until the need for additional surgery is gone and the infection clears up. The specialist may also prescribe antibiotics during the completion of hyperbaric oxygen therapy.

Hyperbaric oxygen therapy. In addition to antibiotics and surgery, hyperbaric oxygen therapy can also be used to treat gangrene. Under increased pressure and increased oxygen content, the blood can carry more oxygen. Oxygen-rich blood slows down the growth of bacteria that thrive in the absence of oxygen and makes infected wounds heal more easily.

In this type of therapy, the patient will be placed in a special chamber, which usually consists of a padded table that is inserted into a clear plastic tube. The chamber is filled with pure oxygen, the pressure inside the chamber will slowly rise to about 2,5 atmospheric pressure. Hyperbaric oxygen therapy for gas gangrene usually lasts about 90 minutes. The patient may need two to three treatments daily.

Other treatments for gangrene may include supportive care, including fluids, nutrients, and pain medication, to reduce discomfort.

Generally, people with dry gangrene have a better chance of making a full recovery because dry gangrene is not associated with a bacterial infection and spreads more slowly than other types of gangrene. However, when gangrene caused by an infection is recognized and treated promptly, the chances of recovery are good.

Prevention of gangrene in adults at home

Here are some tips to help reduce your risk of developing gangrene:

Take care of your diabetes. If you have diabetes, be sure to check your hands and feet for cuts, sores, and signs of infection such as redness, swelling or abrasions, and fluid. Ask your doctor to examine your hands and feet at least once a year and try to keep your blood sugar under control.

Need to lose weight. Being overweight not only puts you at risk for diabetes, it puts pressure on your arteries, restricts blood flow and puts you at risk of infection, and slows down wound healing.

Don’t use tobacco. Chronic use of tobacco products can damage your blood vessels.

Help prevent infections. Wash open wounds with mild soap and water and try to keep them clean and dry until they heal.

Be careful when the temperature is low. Frostbitten skin can lead to gangrene because frostbite reduces blood flow to the affected area. If you notice that any area of ​​your skin has become pale, hard, cold, and numb after prolonged exposure to low temperatures, see your doctor.

Popular questions and answers

We asked neurologist of the highest category Evgeny Mosin about the development of different types of gangrene and the possible problems associated with this condition.