Gangrene

Gangrene refers to the necrosis of organic tissue caused by a lack of blood circulation, severe infection, or the combination of both. It typically affects the external parts of the body, mainly the extremities, although it can also affect muscles and internal organs. It is a serious condition that requires immediate medical attention as it can be life-threatening.

Symptoms

The presentation of gangrene varies depending on its type:

• Dry gangrene: affects the skin and progresses slowly.
• Dry, wrinkled skin.
• Brown, bluish-purple, or black coloration.
• Wet gangrene: progresses very quickly and is the result of a previous bacterial infection.
• Inflammation.
• Blisters or pustules with a wet appearance.
• Often, a foul odor.
• Gas gangrene: affects deep muscle tissue, making it harder to detect. It is uncommon but very severe.
• Intense pain.
• Inflammation.
• As the gangrene advances, the skin turns a grayish or reddish color.
• Blisters that crackle when pressed.
• Internal gangrene: occurs in internal organs.
• Fever.
• General malaise.
• Fournier’s gangrene: occurs in the genital and perineal areas. It progresses very quickly.
• Inflammation.
• Dark-colored discharge.
• Meleney gangrene: occurs after surgical procedures.
• Ulcers surrounded by purple or reddened skin.
• Foul odor.
• Crepitus.

Additionally, gangrene often presents the following symptoms:

• Intense pain.
• Numbness, loss of sensation in the affected area.
• Cold skin to the touch.
• Thin, shiny skin without hair.

Causes

The cause of dry gangrene is the reduction or interruption of blood flow to the affected tissues. When blood flow is interrupted, the tissues' cells cannot receive the oxygen and nutrients they need to survive, causing the tissue to die and decompose. This interruption in blood flow can be due to the following:

• Diseases affecting blood vessels, such as atherosclerosis, diabetes, peripheral artery disease, or Raynaud’s phenomenon.
• Severe cases of frostbite.

In the case of internal gangrene, blood flow is typically blocked by:

• Strangulation of abdominal hernias, leading to intestinal gangrene.
• Obstruction by gallstones, causing gallbladder gangrene.

Wet gangrene, on the other hand, results from prolonged untreated bacterial infection. Bacteria usually enter the subcutaneous tissue through open wounds caused by cuts, burns, trauma, or surgical procedures. Once inside the body, the bacteria multiply rapidly due to the saturation of stagnant blood in the affected area. In doing so, they release toxins that damage blood vessels and surrounding tissues, causing necrosis. In the case of gas gangrene, the responsible bacteria is Clostridium perfringens, whose toxins release gases that expand rapidly and destroy tissues. Fournier’s gangrene is caused by a bacterial infection in the genitourinary area, while Meleney gangrene is secondary to surgery and is often caused by hemolytic streptococci.

Risk Factors

The factors that increase the risk of developing gangrene include:

• Compromised immune system: increases the risk of infection.
• Recent injuries, trauma, or surgeries.
• Prolonged exposure to extreme cold.
• Age: as you age, blood flow decreases, and circulatory disorders become more likely.
• Smoking: smoking negatively affects blood vessels.
• Alcohol abuse: contributes to circulatory problems.
• Obesity: excess weight puts pressure on the arteries and reduces blood flow.
• Diabetes.

Complications

In severe cases of gangrene, when the tissue is significantly damaged, or if the existing infection cannot be controlled and spreads throughout the body, endangering the patient’s life, it may be necessary to amputate the affected body part.

The spread of infection through the bloodstream can also lead to sepsis, which is a generalized and deregulated immune response to infectious agents. This causes a systemic inflammatory reaction that leads to septic shock: a significant drop in blood pressure, resulting in multiple organ failure. If the damage is severe, it can cause the patient's death. This is particularly common in cases of gas gangrene or Fournier’s gangrene due to the rapid spread.

Prevention

Preventing the development of gangrene involves taking measures against its risk factors:

• Properly care for wounds, cleaning and disinfecting them thoroughly. Additionally, especially in cases of diabetes and other conditions affecting sensitivity, skin should be checked regularly for injuries.
• Protect yourself from extreme cold with appropriate clothing and footwear.
• Maintain a healthy weight.
• Avoid tobacco and reduce alcohol consumption.

Which doctor treats gangrene?

Gangrene is diagnosed and treated by specialists from various fields, such as internal medicine, vascular surgery, general surgery, plastic surgery, and dermatology.