Gangrene

What is gangrene?

Gangrene is a pathology that manifests after a blockage of the blood supply to one or more tissues, followed by necrosis and decay of the latter. It usually affects the hands and feet, but internal organs and muscles are not exempt from risk.

People suffering from diseases such as diabetes, arteriosclerosis and other disorders affecting the blood vessels are more at risk of developing gangrene.

Gangrene can be of different types:

  • Dry gangrene: this is characteristic of diabetes and arteriosclerosis and is usually caused by a lack of blood supply to a limb or tissue, which is gradually reduced. It does not involve a bacterial attack.
  • Moist or wet gangrene: caused by bacterial proliferation that enters the organism taking advantage of the presence of an untreated and infected wound to thrive; also in this case it is characterized by ischemia (absence of blood to the affected area).
  • Gas gangrene: caused by the spread of toxins generated by bacteria attacking an open wound.

Gangrene occurs when there is a blockage in the irradiation of blood to the tissues.

Prognosis of the disease

The prognosis can be lethal if gangrene is not diagnosed and treated as early as possible.

In the case of wet gangrene, the progression of the disease is quite rapid and can lead to septicemia, or general infection of the body, which is often fatal if it triggers septic shock.

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Dry gangrene, if affected by bacterial infection, may develop into wet gangrene and be subject to the same complications.

The limb affected by gangrene may need to be removed or skin resections of varying size may be necessary.

Symptoms of gangrene

When a limb or the skin is affected by gangrene, the symptoms are as follows:

  • The skin becomes black, green, brown, brown or bright red in color.
  • The wound emits a purulent fluid or blood, and is visibly infected.
  • The affected limb or tissue loses sensation
  • In the case of dry gangrene, the skin or limb is black, dry and withered.

In the case of wet gangrene, the following phenomena may be observed:

  • The tissue is distended, soft and swollen
  • The affected part emits a foul odor.

In the case of gas gangrene, the following symptoms are manifested:

  • Septicemia
  • Accelerated heartbeat
  • Fast breathing
  • Fever
  • Hypotension
  • Lightheadedness and confusion
  • Pain
  • Gas in the subcutaneous tissues
  • Discomfort

Diagnosis of gangrene

The most widespread diagnostic modalities are as follows:

  • Objective tissue analysis
  • Blood sampling (gangrene produces an excess of white blood cells).
  • X-ray
  • CT SCAN
  • Magnetic resonance imaging
  • Biopsy of pus emitted from the wound or a tissue sample
  • Arteriogram: may help identify which vein has become blocked and caused the gangrene.

What are the causes of gangrene?

The main causes of gangrene are:

  • Embolisms
  • Thrombosis
  • Bacterial infections
  • Trauma of great intensity causing extensive wounds
  • Freezing
  • Vasculitis
  • Diabetes
  • Atherosclerosis
  • Hypercholesterolemia
  • Other cardiovascular diseases that can cause blockage of some arteries

Can it be prevented?

Patients suffering from diabetes have to undergo frequent checks to measure glycemic levels and avoid blockage of blood flow; they also have to pay attention to every small wound, which should be carefully disinfected.

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It is a good idea to avoid exposure to very cold temperatures, or to wear thick socks and gloves during the winter.

Treatments for gangrene

The earlier you intervene in a case of gangrene, the better the chances of resolving it without consequences. Otherwise, the outcome could be more serious or lead to death.

  • Antibiotic treatment: particularly effective in the case of wet gangrene.
  • Surgical treatment: if gangrene is at an early stage, the already necrotic tissues are removed; if gangrene is already advanced, an organic resection should be performed; if the limb is already irrecoverable, it should be amputated.
  • Revascularization: the combined use of surgical or minimally invasive endovascular revascularization and vasodilator drugs restores adequate blood supply to the affected tissue or limb.
  • A stay in a hyperbaric chamber is particularly effective in the case of gas gangrene or, in some cases, wet gangrene. The patient is placed in a hyperbaric chamber for about an hour and a half several times a day in order to increase the amount of oxygen in the tissues and to slow down bacterial growth.

Which specialist should be contacted?

Those who deal with the diagnosis and treatment of gangrene are Dermatologists and surgeons, as well as specialists in Angiology and Vascular Surgery.