Gangrene Treatment in Delhi, India

Gangrene has many different types, each having a different cause. However, dry gangrene and wet gangrene are the two main types.

1. Dry Gangrene: Dry gangrene is caused by poor blood circulation or lack of blood flow to a certain area in the body. It generally affects the hands and feet. As the dead tissue dries up, foul smells and a change in the colour of the infected part can be noticed. Depending on gangrene severity, the colour changes from brown to black. The dead tissue often falls off easily without causing any pain. In case of infection, dry gangrene can result in wet gangrene.

2. Wet Gangrene: Wet gangrene is caused by an injury and bacterial infection. The common visible symptoms of wet gangrene include swelling, blistering and wetness around the area of infection. Injury, burns or trauma can cause poor blood circulation or cut off blood supply to the area, resulting in tissue death and higher chances of infection. This infected area swells, causing pus. Infection caused by wet gangrene can spread quickly throughout the body. The types of wet gangrene include:

   • Internal gangrene: It's related to an infected internal organ like the appendix or colon that causes severe pain and infection.
   • Gas Gangrene: It is caused by infections inside the body, affecting muscles and internal organs due to trauma. Gas gangrene is dangerous as it releases gas and harmful toxins that can be trapped inside the tissues. This can cause skin discolouration (pale and grey skin) and may make a crackling sound when pressed on the infected area. Gas gangrene can be extremely dangerous and deadly. It requires immediate medical treatment.

3. Fournier's Gangrene: It is a rare condition caused by an infection in the genital area. It affects and occurs in men more than women. If the infection spreads to the bloodstream, it leads to a condition called sepsis, which can be life-threatening.

The symptoms vary depending on the type, but the pain is the common symptom for dry and wet gangrene.

The other early symptoms of dry gangrene include:

• Skin colour changes from blue to black, and dead tissues eventually come off
• Severe pain followed by numbness
• Extreme swelling and reddening of the skin
• Cold and numb skin

The symptoms of wet gangrene include:

• Skin discolouration (ranging from red, brown, purple, blue or black skin)
• Swelling and pain
• Fever and uneasiness
• Loss of appetite
• Blisters
• Ulcer with the foul-smelling discharge of pus
• Dizziness

If gangrene has affected an internal area or organ, the most common symptoms include fever, confusion, gas, persistent pain, and low blood pressure.

The major causes of gangrene include:

• Poor blood Circulation: Proper blood supply ensures the body gets oxygen and nutrients, providing the immune system with antibodies. Lack of oxygen supply causes tissue decay.
• Infection: Any untreated bacterial infection can lead to gangrene.
• Traumatic Injury: Serious injury or wounds can act as a passway for bacteria to enter the body.

Gangrene diagnosis is based on physical examinations and tests and medical history. The doctor will examine the symptoms and will want to know of any long-term health conditions or any recent injuries. After analysing the symptoms, the doctor may suggest:

• Blood Test: A blood test can identify bacteria and check for any major signs of infection.
• Imaging Tests: Imaging tests like X-rays, MRI scans, and CT scans can be used to identify the presence of gangrene. These tests are also useful for the examination of blockages in blood vessels. It helps identify whether the gangrene has spread to the body or if the gas has built up in the tissues.
• Surgery: Surgical examination is conducted to confirm if there is gangrene inside the body, most likely affecting internal organs and muscles
• Tissue Culture: A small tissue sample or fluid sample is collected from the infected area to test which bacteria are responsible for gangrene and determine the antibiotic to treat the condition.

Treatment involves removing dead or affected tissue and treating gangrene to prevent the spread of infection. Gangrene requires urgent medical attention for easier and quicker recovery. Depending on the type of gangrene, treatments include:

Surgery: Surgery is one of the fastest methods to remove dead tissue and minimise infection from spreading. It also allows the surrounding healthy tissues to heal. In case of severe damage, the doctor might remove an infected part like a finger or toe.

Antibiotics: Gangrene can be treated with antibiotics in the form of tablets or injections. Injections are given in case of severe infection; directly injecting into the vein allows the doses to reach the affected area faster.

Lack of blood flow is one of the major reasons that cause gangrene. People at higher risk of gangrene are those with major health issues that affect blood vessels, leading to poor blood circulation and weakened immune systems. Although the blood vessels are naturally narrow, any extra damage can block the blood flow to a part of the body and cause gangrene. Major health issues that can lead to gangrene include:

• Diabetes
• Trauma
• Peripheral vascular disease (narrowing of blood vessels reducing the blood circulation to limbs)
• Ulcers and skin infections
• Urinary tract infection
• Tonsillitis (sore throat)
• Immune deficiency

Gangrene can be prevented in many cases. In case of a condition that increases the chances of getting gangrene, such as diabetes or immune deficiency, one must have regular check-ups with the doctor.

Gangrene can be prevented by adopting a healthy lifestyle by including a balanced diet and regular exercise in the routine. In addition, stop any nicotine and alcohol intake to improve the immune system. These changes can improve blood circulation and help reduce the risk of developing gangrene.

Reviewed by Dr. Ashish Vashistha, Senior Director & HOD - General Surgery & Robotics, Department of General Surgery and Robotics, Laparoscopic / Minimal Access Surgery, Robotic Surgery on 20-Jan-2023.