GANGRENE

General Information

DEFINITION--Dead tissue. Gangrene develops when a wound becomes infected or tissue is destroyed by an accident. It can involve any body part, but the most common sites are toes, feet, legs, fingers, hands and arms. The most dangerous sites are abdominal organs. There are two types, dry gangrene where there is no bacterial infection and wet gangrene when a wound becomes infected with bacteria. The term gas gangrene pertains to a form of wet gangrene.

BODY PARTS INVOLVED--Any body part, but the most common sites are toes, feet, legs, fingers, hands and arms. The most dangerous sites are abdominal organs.

SEX OR AGE MOST AFFECTED--Both sexes; all ages.

SIGNS & SYMPTOMS

• Black skin with dead underlying muscle and bone.
• Crepitation of the skin. This feels like pressing on air bubbles under the skin.
• Swelling.
• Severe abdominal pain.
• Pain or loss of sensation in affected area.
• Bad-smelling discharge from ulcers in dead tissues.
• Moderate fever up to 101F (38.3C).

CAUSES--

Gangrene occurs when blood flow to a body part is blocked or severely reduced. The following may interrupt blood flow and cause gangrene:

• Infection with clostridia perfringens germs.
• Tissue injury caused by accidents, surgery or deep puncture wounds.
• Crushing injury that cuts off blood supply.
• Blood clot in artery or hardening of arteries.
• Prolonged frostbite.
• Ruptured appendix or gallbladder.
• Herniated bowel.
• Burning by heat or acid.

RISK INCREASES WITH

• Diabetes mellitus.
• Smoking, which impairs blood circulation.
• Excess alcohol consumption, which interferes with blood-vessel function.
• Poor blood circulation; older age.
• Raynaud's phenomenon; Buerger's disease.

HOW TO PREVENT

• If you have diabetes, adhere closely to your treatment program to control diabetes. Examine your feet often for signs of unhealthy tissue. Keep your nails trimmed. Wear comfortable, well-fitting shoes.
• Burned skin requires careful, antiseptic handling to avoid infection.
• Handle frostbitten skin with great care.
• Consult your doctor for signs of infection (warmth, swelling, redness, pain or tenderness) in a skin injury.
• Avoid trauma.
• Don't smoke.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and exam by a doctor.
• Cultures from the gangrene site or blood.
• X-rays of any suspicious area to detect gas in tissues.

APPROPRIATE HEALTH CARE

• Doctor's treatment and hospitalization.
• Surgery to remove dead tissue, sometimes by amputation; surgery for abdominal organs.
• Physical therapy, if amputation is necessary.

POSSIBLE COMPLICATIONS

• Blood poisoning or shock.
• DIC (disseminated intravascular coagulation), a blood-clotting disorder.
• Limb amputation to prevent death.
• Death, if not diagnosed in abdominal organs.

PROBABLE OUTCOME--Usually curable in the early stages with antibiotic treatment and surgery to remove dead tissue. Without treatment, gangrene may lead to fatal infection.

How To Treat

GENERAL MEASURES----The family should maintain an optimistic outlook, stay in close contact with the patient's doctor and help by making their visits with the patient brief and as supportive as possible.

MEDICATION--Your doctor may prescribe:

• Antibiotics--usually intravenously in the early stages--to fight infection.
• Pain relievers.
• Anticoagulants to prevent blood clotting.

ACTIVITY--

• Rest in bed until gangrene stops progressing and healing begins. Then resume activity gradually.
• Physical therapy, if amputation is necessary.

DIET--

• Eat a high-protein, high-calorie diet while your body is repairing damaged tissue.
• Take vitamin and mineral supplements, including zinc. Ask your doctor for advice.
• Drink adequate fluids (6 to 8 glasses daily).

Call Your Doctor If

• You have symptoms of gangrene.
• You have persistent pain, despite treatment.
• Fever develops during convalescence.