Diagnosis and treatment of gangrene

www.news-medical.net/health/Diagnosis-and-treatment-of-gangrene.aspx
By Dr Ananya Mandal, MD
Gangrene is caused by death of tissues due to lack of blood supply. This may be caused by long term diseases that
lead to damage to blood vessels like diabetes or
due to blood vessel injury like in burns or injuries that give way to

deeper tissue infections. These infections cause the part to swell up leading to occlusion of blood vessels.

Diagnosis of gangrene
Diagnosis of gangrene is based on history, physical examination and clinical and laboratory tests.
Medical history may indicate a long term health condition like diabetes, high blood cholesterol, injury in an accident
or burn.
Physical
examination shows discoloration of the affected area. In case of dry gangrene there is a dried, cool and
black appearance of the affected limb.
Wet gangrene on the other hand leads to a swelling of the limb or the affected area. There is evidence of collection
of foul smelling pus. (1-5)

Laboratory tests for gangrene

Laboratory tests include;
Blood tests - Routine blood tests indicate rise in white blood cells. There may be high blood sugar detected in

diabetics. Sometimes diabetes may present initially as a case of gangrene. In patients with arteriosclerosis
there may be high cholesterol.
Examination of pus - The pus from the gangrene
especially wet gangrene is examined under the microscope.
The fluids may be tested for bacteria after staining it with special dyes called Gram stain. Bacteria are stained
with a dye and examined under a microscope. The tests are also useful to detect the antibiotics that are
potent
against the infective organism.
Blood culture - Blood culture is performed to check for the actual growth of bacteria present in the blood.
Radiographical imaging - Radioimaging studies include X rays, CT scans and MRI scans. These help detect
the blockages in the blood vessels.
Surgical examination - Surgical examination is needed to confirm a diagnosis of gangrene in any of the
internal organs.

Aims of treatment of gangrene

Treatment of gangrene has three important aims (1-5):
Surgical debridement of removal of the infected tissues so that the infection does not spread via the blood
vessels.
The treatment aims at prevention of the infection and its spread.
To
treat and control the underlying condition that leads to the gangrene to prevent recurrence. A vascular or
blood vessel surgery is performed to prevent occlusion and diabetes is controlled to prevent diabetic

gangrene.

Antibiotics
Antibiotics are used to treat the infection. Oral antibiotic pills and intravenous antibiotics are used. Antibiotics may

also be injected into the muscles.

Patients with gas gangrene and infections with Clostridium respond well to antibiotics like:
Penicillin
Clindamycin
Tetracycline
Chloramphenicol
metronidazole and a number of cephalosporins
Some patients also require fluids and nutrients. Pain relievers are advised to reduce the pain associated with
gangrene.

Surgical debridement
Surgical
debridement involves removal of dead tissue that results from gangrene.
This allows for the healthy
surrounding tissue to heal and also prevents spread of infection.

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Sometimes when the gangrene is severe, where the whole part like the toe or finger or limb is affected, surgical
amputation may be the only option available.

Blood vessel surgery

Blood
vessel surgery is of two types bypass surgeries and angioplasty. Bypass surgeries create a diversion. The
diversion redirects the flow of
blood to bypass the obstruction.
Sometimes a process called angioplasty may be performed where a balloon like device placed into a blocked, artery
and inflated to keep the artery open and patent.

Maggot therapy or Biological therapy

Sometimes
a novel therapy called Maggot therapy also known as biological therapy may be applied. There are
certain maggots or fly larvae that are used for debridement to feed on dead and infected tissue.
The maggot leaves the healthy tissue unaffected. These maggots also release some substances that kill bacteria they
also stimulate healing.
These
maggots are specially bred in the laboratory with sterilized eggs. The maggots are put onto the wound and it is
covered with a gauze and dressed. The dressing is cut off after a few days and the maggots are removed.

Alternative treatments of gangrene

Hyperbaric oxygen (HBO) therapy is an alternative treatment. Since gangrene is caused by lack of oxygen this may
help in healing.
The patient is placed within a special chamber and the chamber is filled with pressurised air and a plastic hood with
pure oxygen. The plastic is placed over the gangrenous part. It causes the oxygen to dissolve into the blood and
more oxygen can be delivered into the affected area to speed up healing.
HBO therapy prevents further damage by the bacteria and prevents production of toxins by the existing bacteria.

Prevention of gangrene
Prevention
of gangrene involves keeping blood sugar and cholesterol under control.
Patient is advised a healthy
balanced diet, regular exercise and good foot and limb care.
Diabetics should get their feet checked by podiatrists at least once a year for prevention of foot ulcers that may turn
into gangrene.
Patient should avoid walking barefoot, avoid
harsh chemicals over foot and other extremities, keep feet clean and

dry and avoid burns over the foot.

Stopping smoking can cut down
risk of gangrene. Smoking leads to blockage of small arteries and loss of blood
supply to fingers and toes known as peripheral arterial disease.
Similarly excessive alcohol leads to high cholesterol and arteriosclerosis and blockage of arteries.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)

Further Reading

Last Updated: Nov 23, 2013