Treatment

Treatment is usually surgical debridement, wound care and antibiotic therapy although amputation is necessary in many cases. "Most amputations are performed for ischemic disease of the lower extremity. Of dysvascular amputations, 15-28% of patients undergo contralateral limb amputations within 3 years. Of elderly persons who undergo amputations, 50% survive the first 3 years." In the United States, 30,000-40,000 amputations are performed annually. There were an estimated 1.6 million individuals living with the loss of a limb in 2005; these estimates are expected to more than double to 3.6 million such individuals by the year 2050. Antibiotics alone are not effective because they may not penetrate infected tissues sufficiently. Hyperbaric medicine (HBOT) treatment is used to treat gas gangrene. HBOT increases pressure and oxygen content to allow blood to carry more oxygen to inhibit anaerobic organism growth and reproduction. A regenerative medicine therapy was developed by Dr. Peter DeMarco to treat gangrene using procaine and PVP. He gave his therapy to diabetic patients to avoid amputations. Growth factors, hormones and skin grafts have also been used to accelerate healing for gangrene and other chronic wounds.

Gas Gangrene

Gas gangrene is a bacterial infection that produces gas within tissues. It is a deadly form of gangrene usually caused by Clostridium perfringens bacteria. Infection spreads rapidly as the gases produced by bacteria expand and infiltrate healthy tissue in the vicinity. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency. Gas gangrene is caused by a bacterial exotoxin-producing clostridial species, which are mostly found in soil and other anaerobes (e.g., Bacteroides and anaerobic streptococci). These environmental bacteria may enter the muscle through a wound and subsequently proliferate in necrotic tissue and secrete powerful toxins. These toxins destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen, and 16.1% oxygen was reported in one clinical case.

Gas gangrene can cause necrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid.

Wet gangrene

Wet gangrene occurs in naturally moist tissue and organs such as the mouth, bowel, lungs, cervix, and vulva.[citation needed] Bedsores occurring on body parts such as the sacrum, buttocks, and heels — although not necessarily moist areas — are also categorized as wet gangrene infections. It is characterized by numerous bacteria and has a poor prognosis (compared to dry gangrene) due to septicemia. In wet gangrene, the tissue is infected by saprogenic microorganisms (Clostridium perfringens or Bacillus fusiformis, for example), which cause tissue to swell and emit a fetid smell. Wet gangrene usually develops rapidly due to blockage of venous (mainly) and/or arterial blood flow. The affected part is saturated with stagnant blood, which promotes the rapid growth of bacteria. The toxic products formed by bacteria are absorbed, causing systemic manifestation of septicemia and finally death. The affected part is edematous, soft, putrid, rotten and dark. The darkness in wet gangrene occurs due to the same mechanism as in dry gangrene. Wet gangrene is coagulative necrosis progressing to liquefactive necrosis.

Dry Gangrene

Dry gangrene begins at the distal part of the limb due to ischemia, and often occurs in the toes and feet of elderly patients due to arteriosclerosis. Dry gangrene is mainly due to arterial occlusion. There is limited putrefaction and bacteria fail to survive. Dry gangrene spreads slowly until it reaches the point where the blood supply is adequate to keep tissue viable. The affected part is dry, shrunken and dark reddish-black, resembling mummified flesh. The dark coloration is due to liberation of hemoglobin from hemolyzed red blood cells, which is acted upon by hydrogen sulfide (H2S) produced by the bacteria, resulting in formation of black iron sulfide that remains in the tissues. The line of separation usually brings about complete separation, with eventual falling off of the gangrenous tissue if it is not removed surgically, also called autoamputation. Dry gangrene is actually a form of coagulative necrosis. If the blood flow is interrupted for a reason other than severe bacterial infection, the result is a case of dry gangrene. People with impaired peripheral blood flow, such as diabetics, are at greater risk of developing dry gangrene.

Causes

Gangrene is caused by infection or ischemia, such as by the bacteria Clostridium perfringens[5] or by thrombosis (a blocked blood vessel). It is usually the result of critically insufficient blood supply (e.g., peripheral vascular disease) and is often associated with diabetes and long-term smoking. This condition is most common in the lower extremities. The best treatment for gangrene is revascularization (i.e., restoration of blood flow) of the affected organ, which can reverse some of the effects of necrosis and allow healing. Other treatments include debridement and surgical amputation. The method of treatment is, in general, determined depending on location of affected tissue and extent of tissue loss. Gangrene may appear as one effect of foot binding.

Gangrene

Gangrene is a serious and potentially life-threatening condition that arises when a considerable mass of body tissue dies (necrosis). This may occur after an injury or infection, or in people suffering from any chronic health problem affecting blood circulation. The primary cause of gangrene is reduced blood supply to the affected tissues, which results in cell death. Diabetes and long-term smoking increase the risk of suffering from gangrene.

The immune system is a system of biological structures and processes within an organism that protects against disease. To function properly, an immune system must detect a wide variety of agents, from viruses to parasitic worms, and distinguish them from the organism's own healthy tissue.