Gangrene

Gangrene is a condition that occurs when body tissue dies. It is caused by a loss
of blood supply due to an underlying illness, injury, and/or infection. Fingers, toes, and limbs
are most often affected, but gangrene can also occur inside the body, damaging organs and
muscles. There are different types of gangrene and all require immediate medical attention.

Gangrene Causes
Gangrene may occur due to one or some of the following causes:
- Lack of blood supply. Our blood provides oxygen, nutrients to feed our cells, and
immune system components, such as antibodies, to ward off infections. Without a
proper blood supply, cells can't survive, and our tissue decays.
- Infection. If bacteria thrive unchecked for long, infection can take over and cause our
body tissue to die, causing gangrene.
- Trauma. Wounds that are traumatic, such as gunshot wounds or crushing injuries
from car crashes, can cause bacteria to invade tissues deep within the body. When
such tissues are infected, gangrene can occur.

Types of Gangrene
The two main forms of gangrene are known as dry and wet gangrene.
- Dry gangrene
Dry gangrene is sometimes called mummification. It starts more slowly than wet gangrene,
and it is most commonly associated with chronic disease, including diabetes.
The skin becomes dry, shriveled, and usually dark in color, ranging from brown to purplish-
blue and feels cool or cold to touch.
Blood vessel diseases such as atherosclerosis commonly cause dry gangrene.
- Wet gangrene
In wet or moist gangrene, the skin swells and blisters form and may rupture. Pus may appear.
It is generally associated with infection of the dead tissue. Wet gangrene can develop
following a severe burn or frostbite.
This type of gangrene can occur in people with diabetes who have an injury but do not notice
or attend to it due to diabetic neuropathy. Wet gangrene needs to be treated immediately
because it spreads quickly and can be fatal.
Other types, such as gas gangrene, Fournier's gangrene, and internal gangrene, are less
common.

Signs and Symptoms of Gangrene

Signs
- Skin discoloration — ranging from pale to blue, purple, black, bronze or red,
depending on the type of gangrene that we have. The area will become discolored and
 eventually turn dry and dark. The color will change from red to black in dry gangrene,
or it will become swollen and foul-smelling in wet gangrene.
- A clear line between healthy and damaged skin
- Swelling or the formation of blisters filled with fluid on the skin
- A foul-smelling discharge leaking from a sore
- Thin, shiny skin, or skin without hair

Symptoms
- Sudden, severe pain followed by a feeling of numbness
- Skin that feels cool or cold to the touch
- Persistant fever and feeling unwell
- Low blood pressure
- A crackling noise that comes from the affected area when pressed
- Lacking a sense of touch in an affected area and inability to move the part

Treatment for Gangrene

- Antibiotics
Gangrene that's caused by an infection can usually be treated with antibiotics, which can be
given as tablets or injections.
Injections are usually necessary if we need surgery or we have a severe infection.
Injecting antibiotics directly into a vein allows larger doses to be given and means that they're
more likely to reach the affected area.
To counter the effects of infection and accelerate the healing process, we also need fluids and
nutrients into a vein (intravenous fluids) and we may need blood transfusions.
- Surgery
Surgery to cut out the dead tissue, known as debridement, is often necessary to prevent the
gangrene from spreading and to allow the surrounding healthy tissue to heal.
For example is Larval debridement therapy (biosurgery) and Reconstructive surgery.
- Amputation
In severe cases of gangrene, where a whole body part, such as a finger, toe, or limb, is
affected and debridement is unlikely to help, amputation may be considered.
Amputation can prevent gangrene spreading to other parts of the body and can be used to
remove a severely damaged limb so an artificial (prosthetic) limb can be fitted.
Unless immediate emergency treatment is needed, a decision to amputate will only be made
after a full discussion between patients and the health professionals that treating the patients.