is a form of localized tissue or organ death (necrosis)
from the prolonged blockage of blood-supply to the
tissue. Gangrene can occur in the presence of
arteriosclerosis, diabetes, a decubitus ulcer, severe
burns, or frostbite. Gangrene usually affects the
extremities, such as the toes, feet, legs, fingers,
hands, and arms, but can 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.
In dry gangrene, the decrease in the blood-supply is
gradual, turning the affected part discolored and cold,
then dark and dry. Treatment requires improving blood
flow. Moist gangrene comes from a sudden blood-supply
cutoff. Bacterial infection causes swelling, discoloration,
and then a foul smell. Along with antibiotics, tissue
removal may be needed to prevent spread, which can be
fatal. Gas gangrene is caused by a bacterial infection
(generally from clostridium bacteria). Gas bubbles are
produced under the skin by a highly lethal toxin from
the bacteria, and the wound oozes a brownish, smelly pus.
Infection spreads rapidly, causing death. All dead and
diseased tissue must be removed and antibiotics given;
an antitoxin can also be used.
Symptoms of Gangrene
Areas of either dry or moist gangrene are initially
characterized by a red line on the skin that marks
the border of the affected tissues. As tissues begin
to die, dry gangrene may cause some pain in the early
stages, though this may go unnoticed in those
individuals with diminished sensation to the affected
area. Initially, the area becomes cold, numb, and
pale. As the gangrene continues the area changes in
color to brown, then black. This dead tissue gradually
separate from the healthy tissue and fall off.
In moist and gas gangrene, there is generally a
sensation of heaviness in the affected region that
is followed by severe pain. The pain is caused by
swelling resulting from fluid or gas accumulation
in the tissues. This pain peaks, on average, between
one to four days following the injury, with a range
of eight hours to several weeks. The swollen skin
may initially be blistered, red, and warm to the
touch before progressing to a bronze, brown, or
black color. In approximately 80% of cases, the
affected and surrounding tissues produce crackling
sounds (crepitus), as a result of gas bubbles
accumulating under the skin. The gas may be
palpable (felt) beneath the skin. In moist gangrene,
the pus is foul-smelling, while in gas gangrene,
there is no true pus, just an almost "sweet"
smelling watery discharge.
Symptoms of gangrene may include:
Gas gangrene can be a life-threatening condition and
requires immediate medical attention.
- rapid heart rate
- rapid breathing
- altered mental state
- loss of appetite
- pale skin
- numbness at the site of the infection
- severe pain and swelling at the site of injury
- discoloration of the skin, often starting as white
and eventually becoming brownish-reddish or black
- a crackling or rubbing sensation under the skin
- frothy, watery, foul smelling discharge
- dark and red or black muscles and bones if the
skin breaks open
- decreased activity
- vascular collapse
A diagnosis of gangrene is based on a combination of
the patient's history, a physical examination, and the
results of blood and other laboratory tests. The
patientís history is important for signs of recent
trauma, surgery, cancer, or chronic disease. It
will also reveal the presence of symptoms such as
loss of appetite, diarrhea, and vomiting. The physical
examination can indicate signs of infection around
wounds, areas of tenderness, as well as fever, a rapid
breathing, and a rapid heart rate. Blood tests can be
used to determine whether infection is present and to
determine the extent to which an infection has spread.
A sample of drainage from a wound, or obtained through
surgical exploration, can be cultured with oxygen
(aerobic) and without oxygen (anaerobic) to identify
the microorganism causing the infection and to aid in
determining which antibiotic will be most effective.
A sample obtained from a patient with gangrene will
generally contain few, if any, white blood cells and,
when stained (with Gram stain) and examined under the
microscope, will show the presence of purple (Gram
positive), rod-shaped bacteria. Additional tests, such
as x-ray studies and more sophisticated imaging
techniques, such as (CT) or (MRI), may identify areas
of gas accumulation and muscle death (myonecrosis). A
final diagnosis of gas gangrene, however, often requires
surgical exploration of the wound. During the procedure,
exposed muscle may appear pale, beefy-red, or in the
most advanced stages, black. If infected, the muscle
will fail to contract with stimulation, and the cut
surface will not bleed.
The protocol for the treatment of gangrene depends on
the type of gangrene that is present.
Areas of dry gangrene that remain free from infection
(aseptic) in the extremities are most often amputated
Treatments applied to the wound externally (topically)
are generally not effective without adequate blood
supply to support wound healing. Assessment by a
vascular surgeon, along with x rays to determine blood
supply and circulation to the affected area, can help
determine whether surgical intervention would be
Moist gangrene requires the prompt initiation of
intravenous, intramuscular, and/or topical broad-spectrum
antibiotic therapy. In addition, the infected tissue
must be removed surgically (debridement), and amputation
of the affected extremity may be necessary. Pain
medications (analgesics) are prescribed to control
discomfort. Intravenous fluids and, occasionally, blood
transfusions are indicated to counteract shock and
replenish red blood cells and electrolytes. Adequate
hydration and nutrition are vital to wound healing.
In some cases, treated includes the administration of
oxygen under pressure greater than that of the
atmosphere (hyperbaric) to the patient in a specially
Treatment may also require pain medication,
the use of blood thinners
to prevent clotting, the use of physical therapy, and
when necessary, prosthetics.
In the United States, approximately 50% of moist gangrene
cases are the result of a severe traumatic injury.
Among the most common causes are car and industrial
accidents, crush injuries, and gunshot wounds.
Approximately 40% occur following surgery.
Surgeries involving the bile ducts or the intestine are
the most frequent procedures causing gangrene.
Approximately two-thirds of cases affect the extremities,
and the remaining one-third involve the abdominal wall.
When a case of gangrene is not diagnosed and treated in
a timely fashion, it can result in
- permanent tissue damage
- jaundice with liver damage
- sepsis or blood poisoning
If you or someone you love have suffered from
gangrene due to the neglect of a physician or
other health care provider (such as a hospital,
nursing home, or assisted living provider), you
should immediately contact a competent
attorney. The attorney will work with you to
determine the legal options that may be available.
Call or email for a Free Attorney Consultation
Law Office of Joseph A. Hernandez, P.C.
Phone: (781) 461-9400
Toll Free: (866) 461-9400
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