GANGRENE

• INTRODUCTION
• The word "gangrene" comes from the Greek
word "ganggraina" denoting "an eating sore
that ends in mortification (degradation)" of
the flesh.
• Gangrene involves the death of body tissue
due to the loss of blood supply to that tissue,
sometimes permitting bacteria to invade it
and accelerate its decay.
 Gangrene cont...
• DEF: Gangrene is a serious and potentially life-
threatening condition that arises when a
considerable mass of body tissue dies (
necrosis) due to loss of blood supply to that
tissue.
 RISK FACTORS
• Diabetes and
• Long-term smoking increases the risk of
suffering from gangrene.
• Arteriosclerosis.
 CAUSES OF GANGRENE
• The prime cause of gangrene is reduced blood supply
to the affected tissues, which results in cell death.
• The common cause of either wet or dry gangrene is
loss of an effective local blood supply to any tissue.
• Loss of the blood supply means tissues are deprived of
oxygen, thus causing the cells in the tissue to die.
• The most common causes of tissue blood supply loss
are infections, trauma, and diseases that can affect
blood vessels (usually arteries).
 TYPES OF GANGRENE
• There are three main types of gangrene; dry,
wet and gas gangrene.
 1. DRY GANGRENE
• Dry gangrene occurs when tissue death is not
associated with inflammatory changes.
• 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 OF DRY GANGRENE
• Dry gangrene can result from any of a number of
diseases or mechanisms that can reduce or block
arterial blood flow such as:
Diabetes
Arteriosclerosis
Tobacco addiction
• Although the most common diseases that can
cause dry gangrene are diabetes, arteriosclerosis,
and tobacco addiction, there are many other
lesser-known diseases that can lead to this
problem. For example,
 Causes of dry gangrene cont...
• Some autoimmune diseases that attack blood
vessels (vasculitis syndromes) may result in
enough damage to cause dry gangrene.
• In other cases, dry gangrene can result from
various external mechanisms such as burns,
frostbite, and arterial trauma caused by
accidents, wounds, or surgery.
 PATHOPHYSIOLOGGY OF DRY
GANGRENE
• Dry gangrene begins at the distal part of the
limb due to ischemia and often occurs in the
toes and feet especially of elderly patients.
• Dry gangrene spreads slowly until it reaches
the point where the blood supply is
inadequate to keep tissue viable.
• The affected part becomes dry, shrunken and
dark black.
 PATHOPHYSIOLOGGY OF DRY
GANGRENE cont…
• 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 ‘’auto amputation’’.
 CLINICAL FGEATURES OF DRY
GANGRENE
• The early signs are;
• A dull ache and sensation of coldness in the
affected area along with pallor of the flesh. If
caught early, the process can sometimes be
reversed by vascular surgery. However, if
necrosis sets in, the affected tissue must be
removed just as with wet gangrene.
Picture showing: Dry gangrene
 2. WET GANGRENE
• Wet gangrene is coupled with inflammation
and occurs in naturally moist tissue and
organs such as the mouth, bowel, lungs,
cervix, and vulva.
• Bedsores occurring on body parts such as the
sacrum, buttocks, and heels — although not
necessarily moist areas — are also categorized
as wet gangrene infections.,
 CAUSES OF WET GANGRENE
• In wet gangrene, the tissue is infected by
saprogenic microorganisms e.g. bacteria
perfringens, fusiformis, putrificans, etc.
 PATHOPHYSIOLOGY OF WET
GANGRENE
• In wet gangrene, the tissue is infected by
saprogenic microorganisms, which cause tissue to
swell and emit a fetid (stinking or rotten) smell.
• Wet gangrene usually develops rapidly due to
blockage of venous and/or arterial blood flow.
• The affected part is saturated with stagnant blood,
which promotes the rapid growth of bacteria.
• The affected part is edematous, soft, putrid, rotten
and dark.
 PATHOPHYSIOLOGY OF WET
GANGRENE cont...
• The toxic products formed by bacteria are
absorbed causing systemic manifestation of
septicemia, shock and finally death.
• The darkness in wet gangrene occurs due to
the same mechanism as in dry gangrene.
 TYPES OF WET GANGRENE
1. Fournier's gangrene: Is gangrene with
necrotizing tissue that occurs mainly in male
genitalia and groin.
2. Internal gangrene: Is a general term that
means gangrene is affecting an internal organ.
Internal gangrene types are usually named
after the organ that is affected (for example,
gangrene of the appendix, gangrenous
gallbladder, and gangrenous bowel).
Picture showing: Wet gangrene
 3. GAS GANGRENE
• DEF: Gas gangrene is a bacterial infection that
produces gas within tissues.
• It is a deadly form of gangrene usually caused
by Clostridium perfringens (formerly called,
Clostridium welchii) bacteria.
• Gas gangrene means gas is present in the
gangrenous tissue. 
 RISK FACTORS FOR GAS GANGRENE
• Deep traumatic wounds involving the muscles
• Contaminated wounds with soil, feaces or
clothes are most susceptible
• Lower limb amputation performed for
ischemia (infections from the patient’s own
bowel) and in high velocity gunshot wounds.
 PATHOPHYSIOLOGY OF GAS
GANGRENE
• 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 spread rapidly and destroy nearby tissue,
generating gas at the same time which gives rise to the
characteristic clinical sign of ‘’creptus’’ (crackling) on
palpation.
 PATHOPHYSIOLOGY OF GAS
GANGRENE cont…
• A gas composition of 5.9% hydrogen, 3.4%
carbon dioxide, 74.5% nitrogen, and 16.1%
oxygen was reported in one clinical case.
• Infection spreads rapidly as the gases
produced by bacteria expand and infiltrate
healthy tissue in the vicinity.
 PATHOPHYSIOLOGY OF GAS
GANGRENE cont…
• Gas gangrene involves the invasion of a deep
penetrating wound (in which the blood supply is
compromised) by anaerobic bacteria (bacteria that can
survive with little or no oxygen) such as members of
Clostridium family of bacteria.
• Toxins are absorbed into the general and cause rapid
clinical deterioration and death within 24-48 hours
unless the process is haulted by timely vigorous
intervention.
• Gas gangrene can cause necrosis, gas production, and
sepsis.
• Progression to toxemia and shock is often very rapid.
 CLINICAL FEATURES OF GAS
GANGRENE
• The overlying skin turns black and
• The process spreads at an alarming rate within
hours of onset
• Later the skin breaks down and a thin foul-
smelling prulent exudates leaks from the
wound.
 TREATMENT FOR GANGRENE
• 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.
• The method of treatment is, in general, determined
depending on location of affected tissue and extent of
tissue loss.
• Because of its ability to quickly spread to surrounding
tissues, gas gangrene should be treated as a medical
emergency.

• Hyperbaric oxygen therapy

END!!