Gangrene

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Gangrene is death of body tissue due to a lack of blood flow or a serious bacterial infection. Gangrene commonly affects the arms and legs, including the toes and fingers, but it can also occur in the muscles and in organs inside the body, such as the gallbladder.

Your risk of gangrene is higher if you have an underlying condition that can damage your blood vessels and affect blood flow, such as diabetes or hardened arteries (atherosclerosis).

Treatments for gangrene include surgery to restore blood flow and remove dead tissue, antibiotics if there is an infection, and hyperbaric oxygen therapy. The earlier gangrene is identified and treated, the better your chances for recovery.

Gangrene is when part of your body tissue dies. This often occurs because the tissue is not getting enough blood from your circulatory system.

Gangrene usually affects your extremities — the areas farthest from your heart, such as your toes and fingers. However, it can affect other parts of your body as well. Gangrene can even affect your internal organs.

The condition typically starts in a specific body part, such as a leg, hand, or internal organ. Gangrene can spread through your body and cause you to go into shock if left untreated. Shock is a condition marked by a variety of symptoms including low blood pressure. Shock can be life-threatening and is considered a medical emergency.

Gangrene is a medical emergency that could lead to amputations or death. Recognizing and treating the condition as fast as possible will improve your outlook.

Types of gangrene

Dry gangrene

All of your organs (such as your liver, heart, and muscles) need oxygen to function properly and survive. The oxygen is carried to different parts of your body by your blood. Dry gangrene occurs when one of your body parts isn’t getting enough oxygen. Eventually, the body part will start to deteriorate and die. With dry gangrene, the skin is closed and there is no evidence of infection.

Wet gangrene

Wet gangrene happens when your body tissues become infected with some type of bacteria. The tissues react to the presence of the bacteria by growing moist and breaking down. This process causes the death of your tissues. It’s more of an emergency than dry gangrene because of the possibility of infection spreading to other parts of the body.

Gas gangrene

Bacteria called Clostridia cause gas gangrene. These bacteria create an infection that causes gas bubbles and toxins to develop inside the affected area. The resulting gases cause tissue death. This type of gangrene can be fatal, though it’s rare in the United States.

Internal gangrene. Gangrene that affects one or more of your organs, such as your intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked — for example, when your intestines bulge through a weakened area of muscle in your stomach area (hernia) and become twisted.

Left untreated, internal gangrene can be deadly.Fournier’s gangrene. Fournier’s gangrene involves the genital organs. Men are more often affected, but women also can develop this type of gangrene. An infection in the genital area or urinary tract causes this type of gangrene. Meleney’s gangrene. This rare type of gangrene — also called progressive bacterial synergistic gangrene — is usually a complication of surgery. People with Meleney’s gangrene develop painful skin lesions one to two weeks after their operations.

Symptoms

When gangrene affects your skin, signs and symptoms may include:

• Skin discoloration — ranging from pale to blue, purple, black, bronze or red, depending on the type of gangrene you have
• Swelling
• Blisters
• Sudden, severe pain followed by a feeling of numbness
• A foul-smelling discharge leaking from a sore
• Thin, shiny skin, or skin without hair
• Skin that feels cool or cold to the touch

If you have a type of gangrene that affects tissues beneath the surface of your skin, such as gas gangrene or internal gangrene, you may also have a low-grade fever and generally feel unwell.

If the germs that caused the gangrene spread through your body, septic shock can occur. Signs and symptoms of septic shock include:

• Low blood pressure
• Fever, although some people may have a body temperature lower than the normal 98.6 F (37 C)
• Rapid heart rate
• Lightheadedness
• Shortness of breath
• Confusion

When to see a doctor

Gangrene is a serious condition and needs emergency treatment. Call your doctor right away if you have persistent, unexplained pain in any area of your body along with one or more of the following signs and symptoms:

• Persistent fever
• Skin changes — including discoloration, warmth, swelling, blisters or lesions — that won’t go away
• A foul-smelling discharge leaking from a sore
• Sudden pain at the site of a recent surgery or trauma
• Skin that’s pale, hard, cold and numb

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Causes

Causes of gangrene include:

• Lack of blood supply. Your blood provides oxygen and nutrients to your body. It also provides your immune system with antibodies to ward off infections. Without a proper blood supply, your cells can’t survive, and your tissue decays.
• Infection. An untreated bacterial infection can cause gangrene.
• Traumatic injury. Gunshot wounds or crushing injuries from car crashes can cause open wounds that let bacteria into the body. If the bacteria infect tissues and remain untreated, gangrene can occur.

Recognizing the signs of gangrene

External gangrene

Sometimes the first sign of dry gangrene is a reddish line that develops around the affected tissue. This line may later turn black.

Other signs that might indicate you have gangrene include:

• a wound that is red, sore, or swollen
• a wound that is filled with pus or gives off a bad smell
• an isolated area of your body feels cold
• lacking a sense of touch in an isolated area
• sores that keep coming back in the same place on your body
• part of your skin has turned an unusual color (greenish-black, red, blue, or bronze)

Internal gangrene

It’s also possible to experience internal gangrene, which affects your inner tissues or organs. In this case, you may not have any symptoms on your skin or limbs. However, you may have pain, an unexplained fever that lasts a long time, or low blood pressure. You may also experience confusion.

How is gangrene diagnosed?

Your doctor may suspect that you have gangrene based on your medical history and symptoms. They may also use a combination of additional diagnostic methods to determine your condition.

Lab analysis of tissue or fluid samples

A scraping of tissue from your affected body part may be examined with a microscope to look for dead cells.

Blood tests

An abnormally high white blood cell count can indicate a gangrenous infection.

Medical imaging

Some kinds of imaging are helpful in diagnosing the spread of gangrene in your internal tissues. These tests could include X-rays, MRI scans, or CT scans.

An anarteriogram test may be performed if doctors suspect that your gangrene is related to a circulatory problem. This test uses X-rays to monitor the flow of a special dye through your arteries, showing whether any arteries are blocked.

Risk factors

Several factors increase your risk of developing gangrene. These include:

• Diabetes. If you have diabetes, your body doesn’t produce enough of the hormone insulin (which helps your cells take up blood sugar) or is resistant to the effects of insulin. High blood sugar levels can eventually damage blood vessels, decreasing or interrupting blood flow to a part of your body.
• Blood vessel disease. Hardened and narrowed arteries (atherosclerosis) and blood clots also can block blood flow to an area of your body.
• Severe injury or surgery. Any process that causes trauma to your skin and underlying tissue, including an injury or frostbite, increases your risk of developing gangrene, especially if you have an underlying condition that affects blood flow to the injured area.
• Smoking. People who smoke have a higher risk of gangrene.
• Obesity. Obesity often accompanies diabetes and vascular disease, but the stress of extra weight alone can also compress arteries, leading to reduced blood flow and increasing your risk of infection and poor wound healing.
• Immunosuppression. If you have an infection with the human immunodeficiency virus (HIV) or if you’re undergoing chemotherapy or radiation therapy, your body’s ability to fight off an infection is impaired.
• Medications or drugs that are injected. In rare instances, certain medications and illegal drugs that are injected have been shown to cause infection with bacteria that cause gangrene.
• Complications of COVID-19. There have been a few reports of people getting dry gangrene in their fingers and toes after having COVID-19-related blood clotting problems (coagulopathy). More research is needed to confirm this association.

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.

Prevention

Here are a few suggestions to help you reduce your risk of developing gangrene:

• Care for your diabetes. If you have diabetes, make sure you examine your hands and feet daily for cuts, sores, and signs of infection, such as redness, swelling or drainage. Ask your doctor to examine your hands and feet at least once a year, and try to maintain control over your blood sugar levels.
• Lose weight. Excess pounds not only put you at risk of diabetes but also place pressure on your arteries, constricting blood flow and putting you at risk of infection and slow wound healing.
• Don’t use tobacco. The chronic use of tobacco products can damage your blood vessels.
• Help prevent infections. Wash any open wounds with a mild soap and water and try to keep them clean and dry until they heal.
• Watch out when the temperature drops. Frostbitten skin can lead to gangrene because frostbite reduces blood circulation in an affected area. If you notice that any area of your skin has become pale, hard, cold and numb after prolonged exposure to cold temperatures, call your doctor.

Gangrene treatment

Antibiotics

Your doctor may prescribe antibiotics if bacteria are present. These are typically given intravenously, or through a needle directly into the bloodstream.

Vascular surgery

For people with poor circulation that results in gangrene, vascular surgery (surgery on the arteries or veins) may be recommended in order to improve the flow of blood through the veins to body tissues.

Hyperbaric oxygen chamber

Placing a person with gas gangrene in a special oxygen-rich environment can slow the growth of bacteria. This allows the skin to begin healing. It also brings oxygen to the damaged tissue to promote healing.

Tissue debridement

In serious gangrene cases, the dead tissue or body part may need to be removed. This process is called debridement. Debridement can be done with surgical tools or with chemicals. The goal of this type of surgery is to remove the affected areas to prevent the spread of infection and rid the body of the dead tissue.

One alternative form of debridement, known as maggot debridement, uses fly larvae to eat away bacteria and dead tissue. Though rare, this practice can still be used by physicians in the United States and abroad.

Doctors are sometimes able to restore the flow of oxygen to the affected area. Skin grafts can repair any damaged tissue. This procedure uses a piece of your healthy skin from elsewhere on the body to cover the damaged area.

Amputation

For severe cases, amputation of a limb, finger, or toe could be necessary to save your life. People who must have part of an arm or leg amputated due to gangrene may be fitted with a prosthesis, or artificial limb, to replace the missing body part.

What is the long-term outlook for gangrene?

Gangrene can sometimes be treated without serious complications, especially if it is caught early. However, it can lead to amputation in some serious cases, particularly if it’s not treated quickly.

Gangrene can even be fatal for some individuals. This is rare, but it can occur if:

• you have other serious medical issues that complicate your treatment
• the gangrenous area covers a large part of your body
• treatment is not provided quickly enough

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