Definition

Gangrene is the progressive death of body tissue resulting from infection and a lack of blood supply. When the blood supply is cut off, the tissue does not get enough oxygen and begins to die.

Gangrene can be internal or external. The 2 most common types of gangrene are:

• Dry gangrene—Lack of blood supply causes the tissue to die.
• Wet gangrene—Usually occurs when the tissue is infected with bacteria from an injury. The tissue becomes moist and breaks down.

A rare wet type, called gas gangrene or clostridial myonecrosis, develops from specific bacteria deep inside the body. Gas gangrene can be a result of surgery or trauma.

Causes

Gangrene is caused by infection or a reduced blood supply to tissues.

Risk Factors

Gangrene is more common in older adults.

Other factors that may increase your chance of gangrene include:

• Poorly controlled health conditions, such as diabetes or atherosclerosis, which may affect blood vessels
• Health conditions or medications that suppress the immune system
• Perforated bowel
• Severe trauma
• Surgery
• Smoking
• Obesity
• Excessive alcohol use
• IV drug use

Symptoms

External gangrene may cause:

• Color changes, ranging from white, to red, to black
• Shiny appearance to skin
• Foul-smelling, frothy, clear, or watery discharge
• Shedding off of skin
• Severe pain followed by loss of feeling in the affected area

Internal gangrene may cause:

• Fever and chills
• Confusion
• Nausea and vomiting
• Diarrhea
• Lightheadedness or fainting, which may be caused by low blood pressure

If the gangrene is widespread, sepsis can occur.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

• Blood tests
• Tests of the discharge and the tissue

Images may be taken of your bodily structures. This can be done with:

• X-ray
• CT scan
• MRI scan

Treatment

Treatment of gangrene includes:

• IV antibiotics—to treat infection
• Debridement—surgical procedure to cut away dead and dying tissue, done to try to avoid gangrene from spreading
• Supportive care, including fluids, nutrients, and pain medication to relieve discomfort
• Blood thinners—given to prevent blood clots
• Surgery may also be done to restore blood flow to the affected area
• Amputation—removal of severely affected body part
• Hyperbaric oxygen treatment—exposing the affected tissue to oxygen at high pressure may have some benefit

Prevention

To help reduce your chance of gangrene:

• If you have chronic health conditions, follow the treatment plan outlined by your doctor.
• If you have diabetes, inspect your feet every day for cuts, sores, or wounds.
• Care for any cuts, sores, or wounds promptly to avoid infection.
• If you need surgery, ask your doctor about taking antibiotics. This is especially true if you need intestinal surgery.

Family Doctor—American Academy of Family Physicians http://www.familydoctor.org

Health Canada http://www.hc-sc.gc.ca

Clostridial myonecrosis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated October 1, 2014. Accessed August 5, 2015.

Fujiwara Y, Kishida K, Terao M, et al. Beneficial effects of foot care nursing for people with diabetes mellitus: an uncontrolled before and after intervention study. J Adv Nurs. 2011;67(9):1952-1962.

Gangrene. NHS Choices website. Available at:
http://www.nhs.uk/Conditions/Gangrene/Pages/Introduction.aspx
Updated January 27, 2014. Accessed August 5, 2015.

Sepsis in adults. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated July 25, 2014. Accessed September 29, 2014.