Gangrene

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Gangrene. Even the name sounds gruesome, like it came out of a horror movie. Some words just tend to sound like their meaning, and since gangrene is about the death of cells in the body, it seems an appropriate term. Gangrene is not nearly as common since the advent of antibiotics, but it is still a condition that must we must be aware of, and a major health concern that can often be avoided via proper health care.

What is Gangrene?

Gangrene is a condition that results in the death and decay of bodily tissues due to an interruption of blood flow to the affected area, and thus an inadequate supply of oxygen and nutrients.  It is mostly caused by injuries and conditions that impede circulation, and is a greater risk for folks with certain conditions, such as diabetes mellitus. Gangrene can be found externally, most often in the extremities, and internally, typically in the gall bladder and intestines. It is also classified as wet (accompanied by bacterial infection) or dry (no bacterial infection).

What Causes Gangrene?

It says in the Bible that “…the life is in the blood…” , and for good reason. The bloodstream supplies nutrients and oxygen throughout the body, and with out these components, cells, tissues, and entire organs cannot survive. In addition, if the blood supply is interrupted, the immune system cannot deliver white blood cells and other disease-fighting agents where needed. Thus, affected parts of the body are doubly endangered by a lack of life giving building blocks in conjunction with little or no ability to fight disease and infection. When the tissues begin to die, opportunistic infectious agents, such as bacteria and others, grow and thrive without resistance.  Any factor—whether disease or trauma—that impedes or eliminates blood flow to an area, can encourage the occurrence of gangrene. Some common causes for gangrene include:

  • Any injury to blood vessels
  • Frostbite
  • Burns
  • Broken bones (especially compound fractures)
  • Boils
  • Bedsores, especially if infected
  • Deep lacerations and cuts
  • Gunshot wounds
  • Surgical complications
  • Internal wounds
  • Ruptured appendix
  • Blood clots
  • Twisting or crimping of organs
  • Hernias

What Are the Characteristics of the Different Types of Gangrene?

Dry gangrene is called that because its appearance is very dry. Tissues dry up and shrivel from lack of blood supply to the area. This usually takes several weeks to occur, and the skin in affected areas gradually turns from brown to purple to black. Dry gangrene is most often found in folks with circulatory system disorders such as atherosclerosis or diabetes.

Wet gangrene is a much more critical form of gangrene that can progress very quickly. Wet gangrene is accompanied by a bacterial infection, often of the streptococcus or staphylococcus species. The affected area appears wet, and often swells and/or blisters. Wet gangrene is often found in folks who have been severely burned, frostbitten, or due to lack of sensation, such as is the case with some diabetics, sustain a foot or toe injury unawares. Wet gangrene can be very dangerous, and must be treated immediately upon discovery. Some patients have died within hours or days of contracting wet gangrene. Symptoms include:

  • Fever
  • Loss of appetite
  • Vomiting
  • Diarrhea
  • Rapid respirations
  • Rapid heartbeat
  • Vascular collapse
  • Altered consciousness, potentially leading to coma and/or death.

 

Internal gangrene is also a potentially lethal form of gangrene. Whether from trauma that damages an organ or group of organs (such as from an automobile accident) or from disease that causes the blood supply to be internally cut off, this type of gangrene can quickly become critical. Any twisting or distortion of your internal organs, such as a hernia in the intestinal area or a blockage of the gall bladder or appendix, can result in disruption of the blood supply to some areas, and thus cause tissue death. Internal gangrene is usually very painful and accompanied by a fever.

Gas gangrene is a form of the disease that is found most often in deeper muscle tissues. It is a wet form of gangrene that is almost exclusively caused by a bacterial agent known as Clostridium perfringens. Gas gangrene typically forms at the site of an injury or surgery that has been cut off from its blood supply. It can be particularly destructive to tissues because not only does it form due to insufficient blood supply, but the infection with this species of bacteria also produces poisonous gases that destroy tissue cells, damage the walls of blood vessels, and wipe out red blood cells as well. It also damages certain parts of the kidneys in its path of destruction. Gas gangrene can get out of hand very quickly, and it results in hypotension (insufficient blood pressure), kidney failure, and coma, with the potential to be fatal in some cases. One of the telltale signs of gas gangrene is a crackling sound when the swollen skin at the affected site is pressed on. The crackling is the sound of the gas that is present under the skin.

Fournier’s gangrene is a quite rare form of the disorder that attacks the genital area. Men are most often the victims of Fournier’s gangrene, but it can strike women as well. This wet form of gangrene is associated with infections in the genital area and/or urinary tract. It can be very painful, and lead to swelling and tenderness of the genitals.

What Are the Factors That Increase One’s Risk for Gangrene?

Anything that compromises the circulatory system will put you at greater risk for gangrene, especially if the offending condition is combined with an injury or trauma. For example, diabetes damages the blood vessels of the body, so diabetics are in a higher risk group for gangrene. If a diabetic sustains a wound, especially in the extremities, he or she is at an even greater risk for developing gangrene. The same holds true for other maladies that weaken the circulatory system, such as atherosclerosis (“hardening of the arteries.”)  Other issues that can increase risk for gangrene include:

  • Advanced age: The older one gets, the greater the risk for all forms of gangrene. Gangrene is usually rare in younger folks.
  • Compromised immune system: If you are HIV/AIDS positive, are using corticosteroids for an extended period of time, or are undergoing chemotherapy or radiation therapy, your immune system is weakened and you are more susceptible to both infections and gangrene. Anything that interferes with a strong, vibrant immune system is a contributing factor.
  • Severe internal trauma: If damage to internal organs occurs, be aware of increased risk for gangrene, especially if you have any form of circulatory disease, typically diabetes or atherosclerosis. Internal gangrene can be harder to diagnose before it has gotten a strong foothold, and can thus be very difficult to treat.

What Treatments Are Available for Gangrene?

Antibiotic therapy is often prescribed for wet forms of gangrene. Given the dangerous nature of wet gangrene, I would say that their use in such a situation is justified. Promiscuous use of antibiotics can lead to their ineffectiveness when they are genuinely needed, such as when fighting gangrene. Intravenous delivery of antibiotics is typically suggested to aggressively combat gangrene.

Surgery is also an option in some gangrene cases. “Debriding” (removal of dead tissue) is the first course of action. This helps to stop the spread of the gangrene, and makes it easier for the living cells to heal and thrive. (If you don’t like surgery, you can use certain types of fly maggots to debride the wound, like they did in the middle ages. Don’t laugh. This type of therapy is making a comeback in some parts of the world. I wonder if it will ever get FDA approval?)

Sometimes skin grafts can be done as well to replace areas of skin that have been damaged by the gangrene. This procedure will only work if the circulation has been sufficiently restored to the area.

Amputation, or removal of body parts that have been ravaged by gangrene, remains a last resort. However, with the advance of high-tech prostheses, the outlook is not nearly as bleak as it used to be for amputees.

Hyperbaric Oxygen (HBO) therapy is a relatively new treatment that is now being applied to gangrene cases. It involves the inhalation of pure oxygen inside a pressurized chamber. The process allows extensive amounts of oxygen to be introduced to the body via the blood stream. HBO has proven effective at reducing the amounts of toxic gases released by gas gangrene as well. If you choose to undergo HBO, be aware that you may experience some dizziness and disorientation after the treatment. Also, be sure that the technicians that perform the therapy are experienced. There is a certain amount of risk involved if it is not performed correctly.

Chelation therapy is an alternative that has shown a lot of promise as well. It is excellent at cleaning out and strengthening the circulatory system, which can help existing gangrene, and prevent it from occurring too. Incidentally, the cost of chelation therapy is significantly cheaper in certain parts of the world than it is in the United States. The difference may be ten-fold or more between the U.S. and Mexico, for example.

Can Gangrene Be Prevented?

Yes, there are steps you can take to eliminate or drastically reduce your risk for gangrene. The first is to live a clean life that is based on wise wellness choices. This will keep your body healthy across the board and reduce your risk for all types of illness, including gangrene.

If you do develop diabetes, atherosclerosis, or other circulatory conditions, there are some things you can do to minimize the chance of gangrene. First of all, don’t smoke. Tobacco use decreases circulation, especially to the extremities. Secondly, take a thorough inventory of your hands and feet on a regular basis. Attend to any wounds promptly, and this will go a long ways towards preventing gangrene. Thirdly, be particularly careful in cold weather. Circulation problems are always exacerbated during frigid weather. Be sure to keep your hands and feet toasty warm during the winter months.

The prognosis for most forms of gangrene is much better than it was many years ago. However, the best treatment is prevention. Using common sense and making quality lifestyle choices will help to avoid the prospect of having to ever deal with gangrene.

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