Gangrene is the necrosis or death of a body tissue. It is the result of the loss of blood supply to a tissue. Tissue injury and bacterial invasion can also lead to gangrene. People having chronic health problems affecting blood circulation are usually the ones at greatest risk for gangrene. Gangrene is derived from the Greek term “gangraina” meaning putrefaction.
Causes of Gangrene
- Infection or ischemia brings about the development of gangrene. This can be brought about by thrombosis or clots in the blood vessels. Conditions which results to decreased blood supply like peripheral vascular diseases, diabetes and chronic smoking increases the likelihood for ischemia leading to gangrene.
- Infection can be caused by bacteria like Clostridium perfringens and Bacillus fusiformis.
- The lower extremities are usually the most affected body part because it is the most distal for the distribution of oxygen through the circulating blood supply.
Classification of Gangrene
- The most common classifications are the wet gangrene and the dry gangrene. Wet or moist gangrene is the most dangerous among the two. This occurs in moist tissues and organs like the oral mucous membrane, bowel, lungs, vulva and cervix. If left untreated, wet gangrene usually develops into sepsis and could quickly result to death in a matter of a few hours or days because of its poor prognosis. Wet gangrene develops mainly from venous or arterial blockage. Rapid growth of bacteria would then take place. Toxins would then be produced by the bacteria leading to their absorption. Once this occurs, septicemia could result and eventually lead to death. The affected part would usually produce oozing fluid or pus, thus the term “wet.”
- The second type of gangrene is dry gangrene. It usually occurs at the distal part of a limb and is often the result of an ischemia. Arterial occlusion is the primary cause of this classification of gangrene and could lead to the eventual sloughing of the tissue once necrosis sets in. The progression for dry gangrene is slower compared to wet gangrene and could take as much as several months until such that blood supply is no longer viable to keep the tissue. Gas production is absent so infection, pus and feelings of wetness are unlikely. People having problems with circulation are those who are at the greatest risk for developing gangrene. These could include diabetics, people suffering from arteriosclerosis and chronic smokers.
- Other classifications of gangrene are gas gangrene, necrotizing fasciitis and internal gangrene. Gas gangrene is a type of gangrene caused by bacteria releasing gases that infiltrates body tissues. This type of gangrene often leads to shock and toxemia and is usually treated as an emergency case. On the other hand, necrotizing fasciitis is an infection of the fascia, which is a fibrous connective tissue in the body. Internal gangrene is a type of gangrene that occurs internally. Various internal organs may be affected and symptoms of wet gangrene may be visible once the organ is exposed by the surgeon.
Picture 1 : Gas Gangrene
Picture 2 : Wet Gangrene
Picture 3 : Dry Gangrene
Symptoms of Gangrene
The symptoms of gangrene may vary according to the gangrene classification as well as the type of organ involved.
- People with dry gangrene would usually experience numbness in the area and is cool to touch. Discoloration would usually start with redness to brown until it becomes black and shriveled. The area may appear mummified and could eventually slough off.
- As for wet or moist gangrene, the area usually becomes swollen and is quite painful. Signs of decay like sloughed tissues, pus production and local oozing of fluid can take place. A foul odor may develop because of the toxins produced by the bacteria. Fever and other signs of sepsis may also develop.
- In gas gangrene, the area usually becomes infected and bloody discharges are also produced just like in wet gangrene. Similar symptoms of wet and dry gangrene may also occur in gas gangrene. Internal gangrene, in contrast, has minimally obvious symptoms because of the location of the affected area. Usually, the skin overlying the area would become red, swollen and painful to touch. In addition, symptoms of wet gangrene are usually present.
Once a diagnosis of gangrene is established through physical assessment of the clinical symptoms, it is important that treatment would be given at the earliest possible time. Progression of the condition could be as fast as a few hours to a few days. It is therefore vital to seek medical attention once signs and symptoms of gangrene are noted.
The treatment options for gangrene would depend on the type of gangrene and the involvement of other body organs.
- Debridement or the surgical removal of dead or injured tissue is the treatment of choice.
- In worst scenarios, however, amputation may be necessary to prevent the progression of the gangrene to other uninvolved body parts.
- Proper wound care is important as to prevent infection to settle in the new wound.
- Antibiotic therapy is also important as a form of prophylaxis.
- Psychological therapy may be necessary as feelings of low self-esteem and depression may be experienced especially for those having amputation.
- Rehabilitation therapy is also another aspect which may be necessary to help the patient cope and re-adjust to the life without the amputated body part.
In addition, lifestyle modification may also be necessary especially for those who are chronic alcoholics and smokers. Diabetics should also have better control with their blood sugars. Moreover, education regarding proper wound care and prevention is possibly the best weapon against the recurrence of gangrene. Early identification of the signs and symptoms would enable a patient to seek treatment early.
Gangrene is therefore a medical condition that needs to be addressed by a physician. Self-treatment would not be possible for this condition and could in fact just worsen the situation as it would delay medical and surgical treatment. Gangrene therefore should be treated by a physician so as to prevent it from worsening as well as to be able to save the affected area at the earliest possible time.
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