What is gangrene?
Gangrene (“necrotizing soft tissue infection”) is body tissue death from loss of blood supply and, with it, oxygenation. It falls into three major categories:
- Dry gangrene: tissue dries and falls off. This is most commonly seen at the arterial tree terminal points where arterioles are small, such as the ends of the fingers or toes
- Wet gangrene: tissue becomes edematous and blisters form
- Gas gangrene: tissue demonstrates gas bubbles produced by bacteria
Causes of Gangrene
- Peripheral vascular disease, such as that seen in diabetes
- Burns (thermal or chemical)
- Smoking. Nicotine is a powerful vasoconstrictor, which negatively impacts everything from normal tissue oxygenation to impaired healing
- Crush injuries
- Traumatic injuries in which the blood supply to repaired tissue is not successfully re-established, as in reattachment of severed digits or limbs
- Infection that progressed to necrosis (cell death). Sources include breaches in the GI tract, urethral mucosa, oropharynx mucosa after surgery, and dental infection
Signs and Symptoms
- Erythema (redness)
- Edema (swelling)
- Crepitus (crackling sound in the tissue when pressed)
- Overt necrosis or ecchymosis (deep bruised appearance)
The endpoint of necrotizing infections is loss of the areas involved. Amputation above the gangrene may be necessary ultimately. Loss of areas due to separating off, as in dry gangrene, can cause spontaneous loss without surgical intervention, although surgical intervention will be necessary.
Prior to this, gangrene wound management mandates strategies that are implemented to prevent getting to this endpoint.