Gangrene

Gangrene occurs when the blood supply to part of the body is cut off. This depletes the tissues of oxygen and they begin to die. Gangrene usually affects the extremities, such as the toes, feet, legs, fingers, hands, and arms. However, it can also occur in other parts of the body, including the abdomen or intestines.

Gangrene most often occurs after trauma or surgery. Usually gangrene begins 24 hours to 3 days after trauma but may occur anywhere from 3 hours to 6 weeks later. As the tissue begins to die, gases are released, causing bubbling around the tissue. There are two types of gangrene:

• dry gangrene, a condition in which the tissues dry and slough off because the blood vessels are no longer supplying blood to the area
• wet (also called "gas" gangrene), which is usually caused from a bacterial infection of a wound

Symptoms of gangrene may include:

• a crackling or rubbing sensation under the skin
• severe pain and swelling at the site of injury
• numbness at the site of the infection
• discoloration of the skin, often starting as white and eventually becoming brownish-reddish or black color
• dark and red or black muscles and bones if the skin breaks open
• frothy, watery, foul smelling discharge
• fever, with a temperature around 101 degrees F
• pale skin
• decreased activity
• rapid heart beat

Causes of gangrene include:

• a blockage of blood to an organ or tissue
• surgery causing tissue damage
• trauma or injury, such as frostbite, boils, crush injuries, and severe burns, that destroys tissues in the body
• infection of wounds, especially deep wounds
• certain diseases that affect circulation, including atherosclerosis, diabetes, and Raynaud's disease
• blood clots, such as a deep venous thrombosis
• a ruptured appendix caused by appendicitis
• an intestinal hernia
• smoking and drinking alcohol

A person may be able to prevent gangrene in some instances by:

• following sports safety guidelines for children, adolescents, and adults
• getting prompt treatment for deep wounds, burns, crush injuries, or frostbite
• getting treatment for diabetes, Raynaud's disease, and atherosclerosis
• avoiding cigarettes and alcohol

The healthcare professional will start to diagnose gangrene based on a person's medical history and physical exam. Other special tests and scans may be ordered including:

• x-rays to examine the tissues for gas bubbles
• blood tests and blood cultures
• tissues cultures or cultures of any drainage from the wound

Long term effects of gangrene may include:

• permanent death of the tissues in the area affected
• amputation of the affected limb or removal of the affected organ
• sepsis, or blood poisoning
• shock
• death, especially with gangrene of the abdomen or the bowels, if gangrene goes untreated

Gangrene poses no risk to others.

Gangrene must be treated immediately. Dead tissue must be removed surgically. If the tissues or muscles show any signs of swelling, intravenous antibiotics will be needed to treat the infection. Blood thinners to prevent blood clots may also be prescribed. Pain medications are prescribed to treat discomfort.

A person may need to be in the hospital to receive intravenous antibiotics, intravenous fluids, and monitoring of the gangrene. Bed rest is essential in early stages of treatment. Often the affected tissues, organ, or limbs must be amputated so that infection does not spread. Physical therapy may also be needed, especially if amputation occurred.

Side effects depend on the treatments used. For instance, antibiotics may cause allergic reactions and stomach upset. Surgery can be complicated by bleeding, infection, or an allergic reactions to the anesthetic.

Sometimes no further treatment is needed once the cause of the gangrene is identified and corrected. For more serious disease or injury, treatment may continue and a person may have further instructions to follow. If a person had surgery, he or she may need to rest for several days to several weeks and continue with follow-up care. Physical therapy and daily strengthening exercises may be needed.

Any new or worsening symptoms should be reported to the healthcare professional.