Gangrene

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Overview

Gangrene is a clinical condition of ischemic and necrotic tissue, often circumferential around a digit or extremity. It is identified by discolored or black tissue and associated sloughing of natural tissue planes. The three main types of gangrene are wet gangrene, dry gangrene, and gas gangrene.

Dry gangrene is dehydrated ischemic tissue caused by progressive ischemia distal to arterial occlusion, often a progression of peripheral artery disease. Wet gangrene, which may be dry, complicated by a secondary infection, has associated edema and erythema but no crepitus. Gas gangrene is a specific type of necrotizing infection with edema, crepitus, and gas on radiographs. Necrotizing soft tissue infections overlap with the infectious causes of gangrene and involve necrotic skin lesions that may extend into subcutaneous, fascial, and muscle compartments.

The associated tissue loss in gangrene can significantly decrease life quality due to associated pain, limited mobility, and increased risk of hospitalization. These conditions can also progress to substantial morbidity and mortality, with the risk of multiple surgeries and death with the disease progression.

Symptoms

The symptoms of gangrene vary depending on the underlying cause. It can affect any part of the body, but typically starts in the toes, feet, fingers or hands.


General symptoms of gangrene include:


initial redness and swelling 

either a loss of sensation or severe pain in the affected area

sores or blisters that bleed or release a dirty-looking or foul-smelling discharge (if the gangrene is caused by an infection)

the skin becoming cold and pale

Picture of a foot affected by gangreneCredit:

In some cases, the affected limb may feel heavy and pressing the skin may produce a crackling sound. These symptoms are caused by a build-up of gas under the skin.


If the area is infected, you may also have other signs related to the underlying infection, such as:


a high temperature of 38C or above

feeling hot and shivery

loss of appetite

rapid heartbeat and breathing

dizziness


Causes

This can occur as the result of an injury, an infection, or an underlying condition that affects your circulation.


Types of gangrene

There are several different types of gangrene, each with a different cause. The main types are:


dry gangrene – where the blood flow to an area of the body becomes blocked

wet gangrene – caused by a combination of an injury and bacterial infection

gas gangrene – where an infection develops deep inside the body and the bacteria responsible begin releasing gas

necrotising fasciitis – caused by a serious bacterial infection that spreads quickly through the deeper layers of skin and tissue

internal gangrene – where the blood flow to an internal organ, usually the intestines, gallbladder or appendix, becomes blocked


Risk factors

Diabetes. High blood sugar levels can eventually damage blood vessels. ...

Blood vessel disease. ...

Severe injury or surgery. ...

Smoking. ...

Obesity. ...

Immunosuppression. ...

Injections. ...

Complications of COVID-19 .

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Complications

Gangrene can lead to serious complications if it's not immediately treated. Bacteria can spread quickly to other tissues and organs. You may need to have a body part removed (amputated) to save your life.

Removal of infected tissue can lead to scarring or the need for reconstructive surgery.

Left untreated, gangrene may progress to a serious blood infection called sepsis. Sepsis may cause complications including organ failure, extremely low blood pressure, changes in mental status, shock and death.

Prevention

If you have diabetes or another long-term condition that can cause atherosclerosis (hardening or thickening of the arteries), it's important you take extra care of your feet.


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


The advice listed below can help prevent a diabetic foot ulcer developing:


Check your feet daily for problems such as numbness, discolouration, breaks in the skin, pain or swelling. Report problems to your GP immediately.

Avoid walking barefoot outside and wearing shoes without socks.

Don't use chemical preparations for corns and calluses or ingrown toenails. Instead, contact a podiatrist (a healthcare professional who specialises in foot care).

Wash your feet daily with warm water. Afterwards, make sure you dry your feet thoroughly, particularly between the toes.

Wear shoes that fit properly and don't squeeze or rub. Ill-fitting shoes can cause corns and callouses, ulcers and nail problems.

If you have a history of foot ulcers, wearing specially designed therapeutic or orthopaedic shoes can help prevent further ulcers developing. Your podiatrist may be able to provide you with specially made-to-measure footwear, or they may be able to recommend a stockist.


Find out more about taking care of your feet and living with diabetes.


Smoking

Smoking can cause your arteries to become blocked, resulting in a loss of blood supply to your arms or legs. This is known as peripheral arterial disease (PAD).


If you decide to stop smoking, your GP will be able to refer you to an NHS Stop Smoking Service, which will provide dedicated help and advice about the best ways to give up. You can also call the NHS Smoking Helpline on 0300 123 1044.


If you're committed to giving up smoking but don't want to be referred to a stop smoking service, your GP should be able to prescribe medical treatment to help with any withdrawal symptoms you may experience.


For more information about giving up smoking, see 10 self-help tips to stop smoking and stop smoking treatments.


Diet

Eating an unhealthy diet high in fat will make any existing atherosclerosis worse and increase your risk of developing gangrene.


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


There are 2 types of fat – saturated and unsaturated. Avoid foods that contain saturated fats because they increase levels of "bad cholesterol" in your blood.


Foods high in saturated fat include:


meat pies

sausages and fatty cuts of meat

butter

ghee (a type of butter often used in Indian cooking)

lard

cream

hard cheese

cakes and biscuits

food containing coconut or palm oil

Read more about healthy eating and facts about fat.


Alcohol

Drinking excessive amounts of alcohol will cause your blood pressure to rise, and also raise the level of cholesterol in your blood.


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


Read more about alcohol units and get tips on cutting down.


Exercise

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


Unless advised otherwise by your doctor, you should be aiming for at least 150 minutes (2.5 hours) of moderately intense physical exercise a week.


Moderate intensity physical activity is any activity that increases your heart and breathing rate. It may make you sweat but you'll still be able to hold a normal conversation. Examples include:


fast walking

cycling on level ground or with few hills

swimming 

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