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Gangrene

Overview, Causes, & Risk Factors

Gangrene is the death of living cells or tissues of the body.

What is going on in the body?

Gangrene occurs when the blood supply to part of the body is cut off. This depletes the tissues of oxygen and they begin to die. Gangrene usually affects the extremities, such as the toes, feet, legs, fingers, hands, and arms. It may also occur in other parts of the body, including the abdomen or intestines. Gangrene usually occurs after trauma or surgery. Usually gangrene begins 24 hours to 3 days after trauma but may occur anywhere from 3 hours to 6 weeks later. As the tissue begins to die, carbon monoxide and hydrogen gases are released, causing bubbling around the tissue.

There are two types of gangrene:

dry gangrene, a condition in which the tissues dry and slough off because the blood vessels are no longer supplying blood to the area

wet or gas gangrene, which is usually caused from a bacterial infection of a wound

What are the causes and risks of the infection?

Causes of gangrene include:

a blockage of blood to an organ or tissue

surgery causing tissue damage

trauma or injury, such as frostbite, boils, crush injuries, and severe the amount of body surface area, also called BSA, that is injured\ \the depth of destruction\ \the location of the burn\ ',CAPTION,'Burns');" onmouseout="return nd();">burns, that destroys tissues in the body

infection of wounds, especially deep wounds

certain diseases that affect circulation, including atherosclerosis, diabetes, and Raynaud's disease

blood clots, such as a deep venous thrombosis

a ruptured appendix caused by appendicitis

an intestinal hernia

smoking and drinking alcohol

Symptoms & Signs

What are the signs and symptoms of the infection?

Symptoms of gangrene may include:

a crackling or rubbing sensation under the skin

severe pain and swelling at the site of injury

numbness at the site of the infection

discoloration of the skin, often starting as white and eventually becoming brownish-reddish or black color

dark and red or black muscles and bones if the skin breaks open

frothy, watery, foul smelling discharge

fever, with a temperature around 101 degrees F

pale skin

decreased activity

rapid heart beat

Diagnosis & Tests

How is the infection diagnosed?

The healthcare provider will start to diagnose gangrene based on a person's medical history and physical exam. Other special tests and scans may be ordered including:

x-rays to examine the tissues for gas bubbles

blood tests and blood cultures

tissues cultures or cultures of any drainage from the wound

Prevention & Expectations

What can be done to prevent the infection?

A person may be able to prevent gangrene in some instances by:

following sports safety guidelines for children, adolescents, and adults

getting prompt treatment for deep wounds, the amount of body surface area, also called BSA, that is injured\ \the depth of destruction\ \the location of the burn\ ',CAPTION,'Burns');" onmouseout="return nd();">burns, crush injuries, or frostbite

getting treatment for diabetes, Raynaud's disease, and atherosclerosis

avoiding cigarettes and alcohol

What are the long-term effects of the infection?

Long term effects of gangrene may include:

permanent death of the tissues in the area affected

amputation of the affected limb or removal of the affected organ

sepsis, or blood poisoning

shock

death, especially with gangrene of the abdomen or the bowels, if gangrene goes untreated

What are the risks to others?

Gangrene poses no risk to others.

Treatment & Monitoring

What are the treatments for the infection?

Gangrene must be treated right away. If the tissues or muscles show any signs of swelling, intravenous antibiotics will be needed to treat the infection. Blood thinners to prevent blood clots may also be prescribed. Pain medications are prescribed to treat discomfort.

A person may need to be in the hospital to receive intravenous antibiotics, intravenous fluids, and monitoring of the gangrene. Bed rest is essential in early stages of treatment. Often the affected tissues, organ, or limbs must be amputated so that infection doesn't spread. Physical therapy may also be needed, especially if amputation occurred.

What are the side effects of the treatments?

Side effects depend on the treatments used. For instance, antibiotics may cause allergic reactions and stomach upset. Surgery carries a risk of bleeding, infection, and allergic reactions to anesthesia.

What happens after treatment for the infection?

Sometimes no further treatment is needed once the cause of the gangrene is identified and corrected. For more serious disease or injury, treatment may continue and a person may have further instructions to follow. If a person had surgery, he or she may need to take it easy for several days to several weeks and need follow up care. Physical therapy and daily strengthening exercises may be needed.

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare provider.

Attribution

Author:Eileen McLaughlin, RN, BSN
Date Written:
Editor:Smith, Elizabeth, BA
Edit Date:10/03/00
Reviewer:Melissa Sanders, PharmD
Date Reviewed:07/24/01

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

Complete Guide to Symptoms, Illness, and Surgery, H. Griffith, M.D., 2000

Professional Guide to Diseases, Brian Burlew, et al, 1995

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