Gangrene

What is gangrene?

Gangrene is a medical emergency in which blood stops flowing to a specific part of your body, and tissues in that area die. Although gangrene can affect any of your body’s tissues, gangrene usually begins in your fingers, toes, hands or feet. Without prompt treatment, gangrene can be fatal.

What are the different types of gangrene?

There are several different types of gangrene, each with different causes.

What is the difference between wet gangrene and dry gangrene?

Wet gangrene and dry gangrene both happen when blood can’t reach part of your body, and the tissues in that area start to die. But wet gangrene also involves a bacterial infection that can quickly spread to your healthy tissues. This leads to symptoms like blisters, fluid drainage and a foul smell.

Who is at risk for gangrene?

People with certain underlying health conditions that affect their blood vessels face a higher risk. Such conditions include:

• Atherosclerosis: Plaque buildup in your arteries makes it harder for blood to flow through.
• Buerger’s disease: Inflammation of the blood vessels in your limbs leads to blood clots. As a result, less blood can flow through. This usually affects people who smoke or chew tobacco.
• Diabetes: This condition damages your nerves and blood vessels. It also causes wounds to heal more slowly. Slow-healing wounds face a higher risk of infection. Infections in your feet are a common complication of diabetes.
• Peripheral artery disease: Plaque buildup in your limbs prevents enough blood from reaching your legs, feet, arms or hands.
• Popliteal artery entrapment syndrome: Your calf muscle squeezes your popliteal artery. This limits blood flow to your lower leg during exercise.
• Raynaud’s syndrome: Cold temperatures affect the blood vessels in your fingers and toes. Your blood vessels constrict (narrow), limiting blood flow.
• Vasculitis: Inflammation of your blood vessels interferes with blood flow.

People with severe injuries also face a higher risk of gangrene. Such injuries may happen from:

• Car accidents.
• Frostbite.
• Gunshot wounds.
• Severe burns.

People with weakened immune systems may also face greater risk. Causes of a weakened immune system include:

• Alcohol use disorders.
• Being over age 60.
• Chemotherapy
• HIV.
• Kidney failure.
• Long-term use of recreational drugs.

How common is gangrene?

It depends on the type. Critical limb ischemia, which can lead to dry gangrene, affects 1 in 100 adults over age 50. It’s even more common among people over age 70, affecting 1 in 50 adults.

Gas gangrene is less common, affecting about 1,000 people in the U.S. annually. Traumatic injury is the most common cause.

What are the symptoms of gangrene?

Gangrene symptoms vary depending on the cause. General symptoms you may notice in the affected area include:

• Red and swollen skin.
• Severe pain or a loss of feeling.
• Skin that looks pale and feels cool to the touch.

If a bacterial infection causes gangrene, you may have signs and symptoms that include:

• Changes in skin color (from red to brown, and ultimately to purple or greenish black).
• Chills.
• Crackling sound when you press on your skin (this signals there’s a buildup of gas in your tissue).
• Fast breathing and heart rate.
• Feeling hot or sweaty.
• Feeling very anxious.
• Fever.
• Loss of appetite.
• Severe pain.
• Skin that feels firm and tender to the touch.
• Sores and blisters that release blood or foul-smelling pus.
• Vomiting.

What does gangrene look like?

Changes in skin color are a prominent sign of gangrene. Your skin may initially look pale due to a lack of blood flow. But then it turns red. It may then turn brown before turning greenish-black. Your skin may also look swollen, possibly with noticeable sores or blisters.

How does a person get gangrene?

Lack of blood flow to a specific part of your body causes gangrene. Blood delivers oxygen, nutrients and antibodies to your tissues. When your tissues don’t receive blood, their cells begin to die. Infections can develop, and your tissues may start to die.

Causes of blocked blood flow include:

• Infections in your tissue.
• Medical conditions that affect your circulation, like atherosclerosis or peripheral artery disease.
• Severe, deep wounds, especially ones that affect your muscle.
• Surgical complications (rare).

How is gangrene diagnosed?

Healthcare providers diagnose gangrene through a physical exam and testing.

During your exam, your provider will:

• Ask you about your medical history and current medical conditions.
• Ask you about any recent injuries.
• Check your skin for signs of gangrene.

Your provider may also run tests to learn more about your condition and confirm the diagnosis.

What tests diagnose gangrene?

Tests that diagnose gangrene include:

• Blood tests to check for infection.
• Bacteria culture test to determine the bacteria involved and the best antibiotic to treat the infection (if relevant).
• Imaging tests, such as a computed tomography (CT) scan or magnetic resonance imaging, to confirm the diagnosis and assess the spread.
• Tests to check your circulation in the affected area.

What are the treatments for gangrene?

There are several options for gangrene treatment. Your provider will choose the best method or combination of methods for you depending on the cause of your condition and how far it has progressed.

The goals of treatment are to:

• Remove dead or infected tissue from your body.
• Prevent or treat infection to keep gangrene from spreading.
• Help your blood flow better.

Tissue removal

Your provider may perform traditional surgery to remove dead or infected tissue.

Another method is larval debridement therapy, a type of biosurgery. Larval debridement therapy uses maggots bred in a lab to get rid of your damaged tissue. Your provider places these maggots on your wound and covers the area with a bandage. The maggots feed on the dead tissue, and they don’t disturb your healthy tissue. They also release substances that help your skin heal. This process takes a few days.

Another surgical option is amputation. This may be the only option if the gangrene is severe and threatens more of your healthy tissue.

Infection control

When a bacterial infection causes gangrene, you need antibiotics. Your provider will prescribe the proper dosage for you.

Blood flow restoration

A surgeon may perform surgery or a procedure to help blood flow better in your affected blood vessels. Options include:

• Bypass surgery: A surgeon creates a new path for your blood to flow that avoids the blockage.
• Angioplasty: A surgeon inflates a small balloon inside your artery to make it wider so blood can flow through. They may also insert a stent.

Other treatments

Other treatments that help people with gangrene include:

• Hyperbaric oxygen therapy (HBOT): High levels of oxygen circulate through your body’s tissues, helping to heal them. This may help people who have gas gangrene or gangrene caused by diabetic foot ulcers.
• Skin graft surgery: Your provider uses healthy skin from another part of your body to cover scars or damaged skin following treatment.

What happens if gangrene is left untreated?

Without treatment, gangrene may progress to a serious blood infection called sepsis. Sepsis may cause complications including:

• Changes in mental status.
• Dangerously low blood pressure.
• Organ failure.

Sepsis can also be fatal.

How long does it take before gangrene causes death?

It depends on the type of gangrene you have and whether it’s caused by a bacterial infection. Gas gangrene progresses very fast. It’s fatal within 48 hours if you don’t receive treatment. Among people who do receive timely treatment, about 75% survive.

How can I prevent gangrene?

You can do many things to improve your blood flow and prevent gangrene. If you have risk factors like peripheral artery disease or diabetes, it’s especially important to:

• Eat a heart-healthy diet low in saturated fat and cholesterol.
• Exercise regularly, following your provider’s guidance.
• Keep your blood glucose levels within the normal range.
• Learn about complications from diabetes that can affect your legs and feet.
• Quit smoking, and avoid all tobacco products.
• Regularly check your feet and legs for signs of injury or skin breakdown.

It’s also important to practice good foot hygiene and take special care of your feet. Tips include:

• Ask your provider to check your feet every time you have an appointment.
• Never go barefoot, especially outdoors.
• Trim your toenails in a straight line, all the way across. Use a nail file to smooth the corners rather than using clippers to cut them.
• Wash and dry your feet daily. Moisturize any dry spots.
• Wear socks and shoes that fit you well. It’s a good idea to shop for shoes near the end of the day when your feet are at their largest. This ensures you buy shoes that won’t squeeze your feet too tightly.

What is the outlook for people with gangrene?

Your outlook depends on many factors, including:

• How much the gangrene has spread.
• How soon you receive treatment.
• Where the gangrene is located in your body.
• Your overall health.

Gangrene is often fatal or results in limb loss. About 1 in 5 people with gas gangrene need an amputation. Some people may be candidates for a prosthesis (a device to replace a lost limb).

Talk with your provider about your specific prognosis.

When should I seek medical care?

Visit a provider for yearly checkups, and keep all your follow-up appointments. This is especially important if you have risk factors for gangrene such as peripheral artery disease.

Call 911 or your local emergency number immediately if you have signs or symptoms of gangrene. You should also seek emergency help if you have symptoms of septic shock. This is dangerously low blood pressure due to an infection. Symptoms include:

• Fast but weak pulse.
• Feeling confused or disoriented.
• Feeling dizzy when you stand up.
• Skin that’s cold, clammy and pale.
• Trouble breathing.
• Vomiting or diarrhea.

A note from Cleveland Clinic

A gangrene diagnosis is scary, whether it happens to you or a loved one. As with any diagnosis, remember that knowledge can give you power. Learn as much as you can about the condition and treatment options. Prompt treatment gives you or your loved one the best chance of surviving.

As you recover, work with your provider to manage underlying conditions. Targeting the root cause of gangrene can help lower your risk of future problems.