Gangrene – types, causes, symptoms. Gangrene treatment methods

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Gangrene occurs when a lack of oxygen-rich blood causes tissue death in certain parts of the body, often in the hands or feet. This is a serious condition that can result in limb amputation or even death. She needs urgent treatment to stop the spread of tissue death as soon as possible. Stand out among the risk factors for diabetes and smoking, and conditions such as Raynaud’s disease.

Gangrene – what are they?

Gangrene is a term that describes dead or dying tissue that occurs because the local blood supply to the tissue is either lost or insufficient to keep the tissue alive. Gangrene has been recognized as a localized area of ​​tissue death since ancient times. The Greeks used the term gangrain to describe rotting (death) of tissue. Although many lay people associate the term gangrene with a bacterial infection, its medical usage includes any cause that impairs the blood supply (for example, peripheral arterial disease or other blood vessel disease) and causes tissue death in the affected part of the body.

There are two main types of gangrene, known as dry and wet gangrene. In the case of dry gangrene, it occurs as a result of a bacterial infection. All cases of wet gangrene are thought to result from an infection, mainly bacterial. The most common sites for both dry and wet gangrene are fingers (fingers and toes) and other extremities (hands, arms, feet and legs).

See also: The most common bacterial diseases – overview and characteristics

Gangrene – types

Types of gangrene – wet gangrene

Wet gangrene (also called wet gangrene) is the most dangerous type of gangrene because an untreated patient usually develops sepsis and dies within hours or days. Wet gangrene is the result of an untreated (or incorrectly treated) infection in the body in which local blood supply has been reduced or stopped by tissue swelling, tissue gas production, bacterial toxins, or all of these factors combined. In addition, conditions that impede blood flow, such as burns or vascular trauma (for example a knife wound that cuts off blood flow), may occur in the first place. The affected body part or area then becomes infected, which may result in the development of wet gangrene.

Wet gangrene is the type most often thought of when using the term gangrene. It often causes oozing fluid or pus, hence the term “wet”. The early stages of wet gangrene may include:

Symptoms of infection:

1. dull pain along with swelling;
2. redness of the skin if the affected area is above the level of the heart;
3. cool skin;
4. sore;
5. a feeling of crackling of the skin when the skin is pinched due to gas in the tissue.

The mentioned steps can be carried out quickly over a period of hours or days.

See also: Edema: how they arise and what they testify to

Types of gangrene – dry gangrene

Dry gangrene, unless it is contaminated and becomes wet gangrene, usually does not cause sepsis or death. However, it can cause local tissue death and eventually exfoliate the tissue. Usually, the progression of dry gangrene is much slower (the disease may take several days to months to develop) than that of wet gangrene, as vascular trauma develops slowly due to the progression of the disease, which over time can cause local blockage of the arteries.

The stages of development are similar to wet gangrene, except that there is no infection, no pus, no moisture in the affected area, and no crackling sensation because there is no gas production in uninfected tissue.

There are many diseases that can lead to dry gangrene and the most common are:

1. diabetes;
2. atherosclerosis (arteriosclerosis);
3. addiction to tobacco (smoking).

Rarely, dry gangrene can occur quickly, over a period of hours or days, when an artery is suddenly blocked in a part of the body (for example, an arterial blood clot suddenly closes a small artery in your toe). Dry gangrene leads to the drying of the tissues (this process is called scabbing or mummification) without oozing fluid or pus, hence the term “dry”.

See also: Diseases that can kill in one day

Gangrene – causes

A common cause of wet or dry gangrene is loss of effective local blood supply to any tissue. Loss of blood supply means that the tissues are deprived of oxygen, which causes the death of cells in the tissue. The most common causes of loss of blood supply to the tissues and the main risk factors for gangrene are listed below.

1. Diabetes. If we have diabetes, our body does not make enough hormone insulin (which helps cells take up sugar in the blood) or is resistant to insulin. High blood glucose can eventually damage the blood vessels, reducing or interrupting blood flow to parts of the body.
2. Blood vessel diseases. Hardened and narrowed arteries (atherosclerosis) and blood clots can also block blood flow to an area of ​​our body.
3. Major trauma or surgery. Any process that injures the skin and underlying tissue, including trauma or frostbite, increases the risk of developing gangrene, especially if we have an underlying disease that affects blood flow to the damaged area.
4. Smoking. Smokers are more likely to get gangrene.
5. Obesity. Obesity is often associated with diabetes and vascular disease, but the stress of being overweight itself can also constrict arteries, leading to reduced blood flow and an increased risk of infection and poor wound healing.
6. Immunosuppression. If we have human immunodeficiency virus (HIV) infection, or if we are undergoing chemotherapy or radiation therapy, the body’s ability to fight the infection is impaired.
7. Drugs or narcotics that are administered intravenously. Certain drugs and narcotics that are given into a vein have rarely been shown to cause infection with bacteria that cause gangrene.

Rarely, Raynaud’s disease can lead to finger and toe gangrene.

Causes of dry gangrene

Dry gangrene can be the result of any of a number of diseases or mechanisms that can reduce or block arterial blood flow. While the most common diseases that can cause dry gangrene are diabetes mellitus, atherosclerosis, and tobacco addiction, there are many other lesser-known diseases that can lead to this problem. For example, some autoimmune diseases that attack blood vessels (systemic vasculitis) can cause enough damage to eradicate dry gangrene.

In other cases, dry gangrene may result from a variety of external mechanisms, such as burns, frostbite, and arterial trauma from accidents, wounds, or surgery.

See also: Smoking is a disease!

Causes of wet gangrene

Wet gangrene can result from any of the causes of dry gangrene listed above, but always involves infection. In some cases of wet gangrene, infection is believed to be the primary cause. While many types of organisms (mainly bacteria) are known to be involved in wet gangrene infections, the classical bacterial organism or the bacterial infection associated with wet gangrene is Clostridium perfringens, the bacteria that thrives best in the absence of oxygen.

These bacteria can cause muscle necrosis (death of muscle fibers) with exotoxins and create gas bubbles in dead and dying tissues (gas gangrene). This leads to local swelling with pressure and loss of blood flow to the tissue, allowing bacteria to extend the infection into the connective tissue of muscles, skin and other areas, causing necrotizing fasciitis (death of connective tissue). In turn, necrotizing fasciitis allows the infection to spread, often at high speed, from a locally infected site to adjacent areas or into the bloodstream (sepsis). Although this cascade of events is often seen the case Clostridium perfringens as a single type of infecting organism, it can be caused by many other organisms such as Streptococcus, Staphylococcus, Bacteroides i Escherichia.

Usually two or more of these organisms are present in an infection, and many researchers suggest that together the organisms help each other (synergy) in prolonging the infection.

There are several subtypes of wet gangrene:

1. Gas gangrene means that gas is present in the gangrenous tissue as described above.
2. Fournier’s gangrene is gangrene with necrotizing fasciitis that occurs mainly in the male genitalia.
3. Internal gangrene is a general term that means gangrene affects the internal organ. The types of internal gangrene are usually named after the affected organ (for example, gangrene of the appendix, gallbladder gangrene, and gangrene of the intestine involving the colon, rectum, or other areas).

See also: The bacteria that were eating my body

Gangrene and leprosy

Leprosy (Hansen’s disease) is not a type of wet or dry gangrene, although it can cause local tissue loss that may resemble gangrene. It is a disease caused by bacteria that usually spread from person to person. It causes lumps and wounds. Infection M. leprosy slowly destroys peripheral nerve endings in fingers and mucous membranes over the years with loss of sensation.

The fingers and other local areas are repeatedly damaged due to loss of sensation and can become mutilated or atrophy and shed. However, if chronic lesions become infected with other organisms, leprosy patients may develop wet gangrene.

Gangrene – symptoms

The symptoms of gangrene vary depending on the type of gangrene (wet or dry), the anatomical location (external or internal), and the organs affected.

Symptoms of dry gangrene

Dry gangrene often begins with the affected area becoming numb and cool at first. The levels of discomfort vary according to the patient’s perception. A local area (for example, a toe or a hand) begins to discolor, usually turning from reddish to brown and eventually black.

During this time, the area contracts, becomes dry (mummified), and may peel off the body. Dry gangrene from immediate loss of arterial blood supply may turn pale or bluish at first and then proceed as above.

Symptoms of wet gangrene

Wet gangrene, unlike dry gangrene, usually begins with a swollen and very painful affected area, which may initially be red and show signs of rotting (tissue exfoliation, pus, local drainage of fluid).

Often the fluid and the affected area have a very unpleasant odor due to the presence of foul-smelling compounds such as cadaverine and putrescine, which are produced when the infectious agent (s) destroy the tissue. This dead and dying tissue takes on a damp and black appearance. Additional symptoms commonly seen in patients with wet gangrene are fever and other symptoms of sepsis, such as dizziness from low blood pressure.

See also: Five diseases that… can be recognized by their unpleasant smell!

Symptoms of internal gangrene

Internal gangrene, a type of wet gangrene, has less obvious initial symptoms because wet gangrene occurs in the internal organs. The patient may show few, if any, visual symptoms characteristic of wet gangrene. Occasionally, the skin covering an organ with wet gangrene may become reddish or discolored, and the area may become swollen and painful. When the surgeon uncovers an infected organ, signs of wet gangrene are visible.

Symptoms vary somewhat depending on the organ system infected; for example, patients with gangrene of the intestine due to a trapped hernia may experience severe pain at the site of the hernia, while gangrene of the gallbladder may result in severe pain in the upper right corner of the abdomen.

Gangrene – diagnosis

A person should suspect gangrene if any area of ​​the body changes color (especially if it is red, blue or black) and becomes numb or painful. If symptoms include those listed above for dry or wet gangrene, the person should seek immediate medical attention.

Diagnosis is usually based on clinical signs of wet or dry gangrene. Often, in the case of wet gangrene, other tests are performed to further determine the infectious agent (s), the type of gangrene, and the extent of the infection. For example, X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) scans are performed to see how far gases or necrosis (or both) have developed from the affected area. These tests are often performed to help determine the extent of gangrene in both the extremities and the internal types of gangrene. Blood cultures as well as infected tissue and exudate cultures are usually performed to determine the infectious agent (s) and to determine appropriate antibiotic therapy.

For dry gangrene, vascular surgeons often perform angiography (a radiograph using a dye that shows arterial blood flow in the tissues, also called an arteriogram) to see the extent of ongoing or potential arterial blood loss to the tissue.

Gangrene – treatment

Treatment of gangrene depends on the type of gangrene (dry or wet), the subtype of wet gangrene, and the amount of tissue affected by gangrene. In all cases of wet gangrene, and in some cases of dry gangrene, immediate treatment is necessary. Treatment of all gangrene usually includes:

1. surgery;
2. medical treatment;
3. supportive care;
4. Rehabilitation (occasional).

Treatment of dry gangrene

Dry gangrene is usually treated surgically when dead tissue, such as a toe, is removed. The amount of tissue removed may depend on how much arterial blood still reaches other tissues. Often the patient is treated with antibiotics to prevent infection of the remaining living tissue. The patient may also receive anticoagulants to reduce blood clotting.

Supportive care may consist of surgical wound care and rehabilitation to reuse the fingers or limbs. Some patients simply exfoliate the dry gangrene (autoamputation). This most often happens when medical and surgical caregivers are not readily available to the patient in remote areas or in some third world countries. Many patients can recover from autoamputation if they do not become infected.

Treatment of wet gangrene

Wet gangrene is a medical emergency and requires immediate treatment. Treatment is usually performed in a hospital and a surgeon is required to be involved in the entire process as the local area requires debridement (surgical removal of dead and dying tissue). In some patients, debridement will not be adequate therapy and may require limb amputation.

Intravenous antibiotics (usually a combination of two or more broad-spectrum antibiotics, one of which is effective in killing anaerobic bacteria such as Clostridium perfringensand another antibiotic effective against methicillin resistant Staphylococcus aureus or MRSA). Consultation with an infectious disease specialist and surgeon is recommended.

Internal gangrene requires an operation in the hospital to remove the gangrene tissue. Some patients develop sepsis and require the support of an intensive care unit where supportive treatment can be given for other life-threatening problems such as hypotension (low blood pressure). Rehabilitation therapy is strongly recommended for patients with amputation.

See also: Prosthetics – generally and in detail

Gangrene and hyperbaric oxygen therapy

Some clinicians treat gangrene, especially wet gangrene, with hyperbaric oxygen therapy (pressurized oxygen therapy with the patient in a chamber). Since some studies show that hyperbaric oxygen treatment improves the oxygen supply to tissues and can inhibit or kill anaerobic bacteria, this therapy is used to treat patients with gangrene. However, it is not available in many hospitals and is used in conjunction with the therapeutic approaches described above and not as the primary treatment for wet gangrene.

See also: Hyperbaric chamber – operation, indications, contraindications, price

Gangrene and larvotherapy (biosurgery)

In some cases, it may be possible to use larvotherapy, also known as biosurgery, instead of conventional surgery to remove dead tissue.

Certain types of fly larvae are ideal for this as they feed on dead and infected tissue but leave healthy tissue alone. They also help fight infections by releasing substances that kill bacteria and stimulate the healing process.

The larvae used for larval therapy are specially grown in a laboratory using eggs that have been processed to remove bacteria. Worms are placed on the wound and covered with gauze, under a firm dressing that keeps them on the wound (and out of sight). After a few days, the dressing is cut off and the worms are removed.

Medical research has shown that larvotherapy can achieve more effective results than surgical debridement. However, due to the nature of this type of treatment, many people are reluctant to take it.

See also: Infection with screw fly larvae

Gangrene and restoration of blood flow

In some cases, surgery may be performed to restore blood flow to the affected area. The main techniques used to achieve this are:

1. bypass surgery – where the surgeon redirects blood flow and bypasses the blockage by connecting (transplanting) one of the veins to a healthy part of the artery
2. angioplasty – which involves placing a small balloon in a narrow or blocked artery and inflating it to open the vessel; a small metal tube, called a stent, may also be inserted into an artery to keep it open

Research suggests that both techniques are equally effective in restoring blood flow and preventing the need for short-term amputation. Angioplasty has the advantage of having a faster recovery time than bypass surgery, although it may not be as effective in the long term as bypass surgery.

Gangrene – prevention

There are many things you can do to reduce your risk of developing gangrene.

Gangrene and foot care

If we have diabetes or other chronic disease that can cause atherosclerosis (hardening or thickening of the arteries), it’s important that we take special care of our feet.

If we are diabetic, we should have our feet checked at least once a year. However, we may need more frequent check-ups if we have additional risk factors, such as peripheral neuropathy (numbness in the hands and feet) or foot ulcers.

The following tips can help prevent the development of diabetic foot ulcers.

1. Check your feet daily for problems such as numbness, discoloration, skin cracks, pain or swelling. Let us immediately report the problems to our doctor.
2. Avoid walking barefoot outside and wearing shoes without socks.
3. Do not use chemical preparations for corns and calluses or ingrown nails. Instead, let’s contact a podiatrist (a healthcare professional who specializes in foot care).
4. Wash your feet with warm water every day. Then make sure to dry your feet thoroughly, especially between the toes.
5. Wear shoes that fit well and won’t squeeze or rub your feet. Poorly fitting shoes can cause corns and calluses, sores, and nail problems.

If our family has had foot ulcers, wearing specially designed therapeutic or orthopedic shoes can prevent the development of further ulcers. Our podiatrist may be able to provide us with specially made-to-measure footwear or may recommend a distributor.

See also: Five diseases that can be seen on the feet

Gangrene and smoking

Smoking can block the arteries, resulting in loss of blood flow to the arms or legs. This is known as peripheral arterial disease (PAD).

Gangrene and diet

Eating an unhealthy fat-rich diet will worsen existing atherosclerosis and increase your risk of developing gangrene.

Continuing to eat high-fat foods will build up fatty plaques in your arteries. This is because fatty foods contain cholesterol.

There are 2 types of fat – saturated and unsaturated. Avoid eating foods that contain saturated fat because they increase the level of “bad cholesterol” in your blood.

Foods high in saturated fat include:

1. meat pies;
2. sausages and fatty pieces of meat;
3. butter;
4. ghee (a type of butter often used in Indian cooking);
5. lard;
6. cream;
7. hard cheese;
8. cakes and pastries;
9. foods that contain coconut or palm oil.

Gangrene and alcohol

Drinking excessive amounts of alcohol will raise your blood pressure as well as raise your blood cholesterol levels.

Men and women are advised not to drink more than 14 units per week. 14 is equal to 6 pints of medium-strength beer or 10 small glasses of low-strength wine.

Gangrene and exercise

A healthy, well-balanced diet and regular exercise will keep your blood pressure and cholesterol levels at a healthy level, helping to prevent damage to your blood vessels.

Unless your doctor recommends otherwise, aim for at least 150 minutes (2,5 hours) of moderate-intensity exercise per week.

Moderate intensity exercise is any activity that increases your heart rate and respiratory rate. It can make us sweat, but still be able to have a normal conversation. Examples of physical activity include:

1. fast walking;
2. riding a bike on flat terrain or with several slopes;
3. swimming;
4. tennis.

We should choose the physical activities we like as we are more likely to continue them.

It is probably unrealistic to achieve these exercise goals immediately, unless you have exercised a lot in the past. Let’s try to start slowly and gradually increase the number of exercises.

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Gangrene – prognosis

Patients with dry gangrene usually do well unless they become infected. These patients lose some local function due to tissue loss and may re-develop dry gangrene if they have an ongoing disease such as diabetes. Overall, patients recover with minimal problems if there is little tissue loss.

Patients with wet gangrene usually have a worse prognosis than those with dry gangrene. Statistics for the USA suggest that the mortality rate is low in hospitalized patients with gangrene. Mortality increases if the patient becomes infected. If treatment is started early, some patients require some form of amputation (fingers, limbs).

Although the mortality rate remains constant, the number of gangrene cases in the United States has increased in recent years, possibly due to the increasing number of patients with diabetes and other diseases that affect the vascular system, but the data is not complete.