Overview

Gangrene refers to the death of body tissue due to either a lack of blood flow or a serious bacterial infection. Gangrene commonly affects the extremities, including your toes, fingers and limbs, but it can also occur in your muscles and internal organs.

Your chances of developing gangrene are higher if you have an underlying condition that can damage your blood vessels and affect blood flow, such as diabetes or hardened arteries (atherosclerosis).

Treatments for gangrene include surgery to remove dead tissue, antibiotics and hyperbaric oxygen therapy. The prognosis for recovery is better if gangrene is identified early and treated quickly.

Symptoms

When gangrene affects your skin, signs and symptoms may include:

  • Skin discoloration — ranging from pale to blue, purple, black, bronze or red, depending on the type of gangrene you have
  • Swelling or the formation of blisters filled with fluid on the skin
  • A clear line between healthy and damaged skin
  • Sudden, severe pain followed by a feeling of numbness
  • A foul-smelling discharge leaking from a sore
  • Thin, shiny skin, or skin without hair
  • Skin that feels cool or cold to the touch

If you have a type of gangrene that affects tissues beneath the surface of your skin, such as gas gangrene or internal gangrene, you may notice that:

  • The affected tissue is swollen and very painful
  • You're running a low-grade fever and generally feel unwell

A condition called septic shock can occur if a bacterial infection that originated in the gangrenous tissue spreads throughout your body. Signs and symptoms of septic shock include:

  • Low blood pressure
  • Fever, possibly, though temperature may also run lower than the normal 96.8 F (36 C)
  • Rapid heart rate
  • Lightheadedness
  • Shortness of breath
  • Confusion

When to see a doctor

Gangrene is a serious condition and needs immediate treatment. Call your doctor right away if you have persistent, unexplained pain in any area of your body along with one or more of the following signs and symptoms:

  • Persistent fever
  • Skin changes — including discoloration, warmth, swelling, blisters or lesions — that won't go away
  • A foul-smelling discharge leaking from a sore
  • Sudden pain at the site of a recent surgery or trauma
  • Skin that's pale, hard, cold and numb

Causes

Gangrene may occur due to one or some of the following causes:

  • Lack of blood supply. Your blood provides oxygen, nutrients to feed your cells, and immune system components, such as antibodies, to ward off infections. Without a proper blood supply, cells can't survive, and your tissue decays.
  • Infection. If bacteria thrive unchecked for long, infection can take over and cause your tissue to die, causing gangrene.
  • Trauma. Wounds that are traumatic, such as gunshot wounds or crushing injuries from car crashes, can cause bacteria to invade tissues deep within the body. When such tissues are infected, gangrene can occur.

Types of gangrene

  • Dry gangrene. Dry gangrene is characterized by dry and shriveled skin ranging in color from brown to purplish blue or black. Dry gangrene may develop slowly. It occurs most commonly in people who have arterial blood vessel disease, such as atherosclerosis, or in people who have diabetes.
  • Wet gangrene. Gangrene is referred to as "wet" if there's a bacterial infection in the affected tissue. Swelling, blistering and a wet appearance are common features of wet gangrene.

    It may develop after a severe burn, frostbite or injury. It often occurs in people with diabetes who unknowingly injure a toe or foot. Wet gangrene needs to be treated immediately because it spreads quickly and can be fatal.

  • Gas gangrene. Gas gangrene typically affects deep muscle tissue. If you have gas gangrene, the surface of your skin may initially appear normal.

    As the condition progresses, your skin may become pale and then evolve to a gray or purplish red color. A bubbly appearance to your skin may become apparent, and the affected skin may make a crackling sound when you press on it because of the gas within the tissue.

    Gas gangrene is most commonly caused by infection with the bacterium Clostridium perfringens, which develops in an injury or surgical wound that's depleted of blood supply. The bacterial infection produces toxins that release gas — hence the name "gas" gangrene — and cause tissue death. Like wet gangrene, gas gangrene can be life-threatening.

  • Internal gangrene. Gangrene that affects one or more of your organs, such as your intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked — for example, when your intestines bulge through a weakened area of muscle in your abdomen (hernia) and become twisted.

    Internal gangrene may cause fever and severe pain. Left untreated, internal gangrene can be fatal.

  • Fournier's gangrene. Fournier's gangrene involves the genital organs. Men are more often affected, but women can develop this type of gangrene as well. Fournier's gangrene usually arises due to an infection in the genital area or urinary tract and causes genital pain, tenderness, redness and swelling.
  • Progressive bacterial synergistic gangrene (Meleney's gangrene). This rare type of gangrene typically occurs after an operation, with painful skin lesions developing one to two weeks after surgery.

Risk factors

Several factors increase your risk of developing gangrene. These include:

  • Diabetes. If you have diabetes, your body doesn't produce enough of the hormone insulin (which helps your cells take up blood sugar) or is resistant to the effects of insulin. High blood sugar levels can eventually damage blood vessels, decreasing or interrupting blood flow to a part of your body.
  • Blood vessel disease. Hardened and narrowed arteries (atherosclerosis) and blood clots also can block blood flow to an area of your body.
  • Severe injury or surgery. Any process that causes trauma to your skin and underlying tissue, including an injury or frostbite, increases your risk of developing gangrene, especially if you have an underlying condition that affects blood flow to the injured area.
  • Smoking. People who smoke have a higher risk of gangrene.
  • Obesity. Obesity often accompanies diabetes and vascular disease, but the stress of extra weight alone can also compress arteries, leading to reduced blood flow and increasing your risk of infection and poor wound healing.
  • Immunosuppression. If you have an infection with the human immunodeficiency virus (HIV) or if you're undergoing chemotherapy or radiation therapy, your body's ability to fight off an infection is impaired.
  • Medications or drugs that are injected. In rare instances, certain medications and illegal drugs that are injected have been shown to cause infection with bacteria that cause gangrene.

Complications

Gangrene can lead to scarring or the need for reconstructive surgery. Sometimes, the amount of tissue death is so extensive that a body part, such as your foot, may need to be removed (amputated).

Gangrene that is infected with bacteria can spread quickly to other organs and may be fatal if left untreated.

Prevention

Here are a few suggestions to help you reduce your risk of developing gangrene:

  • Care for your diabetes. If you have diabetes, make sure you examine your hands and feet daily for cuts, sores and signs of infection, such as redness, swelling or drainage. Ask your doctor to examine your hands and feet at least once a year, and try to maintain control over your blood sugar levels.
  • Lose weight. Excess pounds not only put you at risk of diabetes but also place pressure on your arteries, constricting blood flow and putting you at risk of infection and slow wound healing.
  • Don't use tobacco. The chronic use of tobacco products can damage your blood vessels.
  • Help prevent infections. Wash any open wounds with a mild soap and water and try to keep them clean and dry until they heal.
  • Watch out when the temperature drops. Frostbitten skin can lead to gangrene because frostbite reduces blood circulation in an affected area. If you notice that any area of your skin has become pale, hard, cold and numb after prolonged exposure to cold temperatures, call your doctor.
July 13, 2017
References
  1. Usatine RP, et al., eds. Dry gangrene. In: The Color Atlas of Family Medicine. 2nd ed. New York, N.Y.: McGraw-Hill; 2013. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  2. Stevens D, et al. Clostridial myonecrosis. http://www.uptodate.com/home. Accessed March 13, 2017.
  3. Bryant A, et al., eds. Gas gangrene and other clostridial infections. In: Harrison's Principles of Internal Medicine. 19th ed. New York, N.Y.: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com/content.aspx?bookid=1130§ionid=79735535. Accessed March 13, 2017.
  4. Conly J., eds. Soft tissue infections. In: Principles of Critical Care. 4th ed. New York, N.Y.: McGraw-Hill; 2014. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  5. Tubbs RJ, et al., eds. Extremity conditions. In: The Atlas of Emergency Medicine. 4th ed. New York, N.Y.: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  6. Lipworth AD, et al., eds. Necrotizing soft tissue infections: Necrotizing fasciitis, gangrenous cellulitis, and myonecrosis. In: Fitzpatrick's Dermatology in General Medicine. 8th ed. New York, N.Y.: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  7. Schwarts BS, et al., eds. Bacterial and chlamydial infections. In: Current Medical Diagnosis & Treatment 2017. 56th ed. New York, N.Y.: McGraw-Hill; 2017. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  8. Ogle JW et al., eds. Infections: Bacterial and spirochetal. In: Current Diagnosis & Treatment Pediatrics. 23rd ed. New York, NY: McGraw-Hill; 2016. http://accessmedicine.mhmedical.com. Accessed March 13, 2017.
  9. Mechem CC, et al. Hyperbaric oxygen therapy. http://www.uptodate.com/home. Accessed March 27, 2017.