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| | __NOTOC__ |
| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Gangrene | | | Name = Gangrene | |
| Image = AUTOAMPUTATE1.JPG| | | Image = AUTOAMPUTATE1.JPG| |
| Caption = Diabetic with severe infection and loss of toes - wet gangrene in center.| | | Caption = Diabetic with severe infection and loss of toes - wet Gangrene in center.| |
| DiseasesDB = 19273 |
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| ICD10 = {{ICD10|R|02||r|00}}, {{ICD10|I|70|2|i|70}}, {{ICD10|E|10|2|e|10}}, {{ICD10|I|73|9|i|70}} |
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| ICD9 = {{ICD9|040.0}}, {{ICD9|785.4}} |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = |
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| eMedicineTopic = |
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| MeshID = D005734 |
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| }} | | }} |
| {{SI}} | | {{Gangrene}} |
| {{CMG}}
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| {{EH}}
| | '''For patient information, click [[Gangrene (patient information)|here]]''' |
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| '''Gangrene''' is a complication of [[necrosis]] (i.e., [[Cell (biology)|cell]] death) characterized by the decay of [[biological tissue|body tissue]]s, which become black and malodorous. It is caused by [[infection]] or [[ischemia]], such as from [[thrombosis]] (blocked [[blood vessel]]). It is usually the result of critically insufficient [[blood]] supply (e.g., [[peripheral vascular disease]]) and is often associated with [[diabetes]] and long-term smoking. This condition is most common in the lower [[extremities]]. 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. Other treatments include [[debridement]] and surgical [[amputation]]. The method of treatment is generally determined depending on location of affected tissue and extent of tissue loss. Gangrene may appear as one effect of foot binding.
| | {{CMG}} {{AE}} [[User:Edzelco|Edzel Lorraine Co, D.M.D., M.D.]] [Mailto:efco@alum.up.edu.ph] |
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| (Images courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
| | ==[[Gangrene overview|Overview]]== |
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| <div align="left">
| | ==[[Gangrene historical perspective|Historical Perspective]]== |
| <gallery heights="175" widths="175">
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| Image:extremities_toe_gangrene2.jpg|Patient with peripheral vascular disease that has lead to infarct of several toes.
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| Image:extremities_toe_no_gangrene2.jpg|Same patient. Normal left foot for comparison.
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| </gallery>
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| </div>
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| ==Etymology== | | ==[[Gangrene pathophysiology|Pathophysiology]]== |
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| The [[etymology]] of gangrene derives from the [[Latin]] word "gangraena" and from the [[Greek language|Greek]] gangraina (γάγγραινα), which means "[[putrefaction]] of tissues".
| | ==[[Gangrene differential diagnosis|Differentiating Gangrene from other Diseases]]== |
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| ==Types of gangrene== | | ==[[Gangrene epidemiology and demographics|Epidemiology and Demographics]]== |
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| ===Dry gangrene=== | | ==[[Gangrene risk factors|Risk Factors]]== |
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| Dry gangrene begins at the distal part of the limb due to [[ischemia]] and often occurs in the toes and feet of elderly patients due to arteriosclerosis. Dry gangrene spreads slowly until it reaches the point where the blood supply is inadequate to keep tissue viable. Macroscopically, the affected part is dry, shrunken and dark black, resembling [[mummy|mummified]] flesh. The dark coloration is due to liberation of [[hemoglobin]] from hemolyzed red blood cells which is acted upon by [[hydrogen sulfide]] (H<sub>2</sub>S) produced by the bacteria, resulting in formation of black iron sulfide that remains in the tissues<ref>[http://compepid.tuskegee.edu/syllabi/pathobiology/pathology/genpath/chapter3.html chapter 3.html<!-- Bot generated title -->]</ref>. The line of separation usually brings about complete separation with eventual falling off of the gangrenous tissue if it is not removed surgically.
| | ==[[Gangrene natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| 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 contracting dry gangrene.
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| The early signs of dry gangrene 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.
| | ==Diagnosis== |
| | | [[Gangrene history and symptoms|History and Symptoms]] | [[Gangrene physical examination|Physical Examination]] | [[Gangrene laboratory findings|Laboratory Findings]] | [[Gangrene x ray|X Ray]] | [[Gangrene CT|CT]] | [[Gangrene MRI|MRI]] | [[Gangrene other imaging findings|Other Imaging Findings]] | [[Gangrene other diagnostic studies|Other Diagnostic Studies]] |
| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:ULCERCELLULITIS1.JPG|Diabetic [[ulcer]]ation with central "dry" gangrene and toward the edges wet gangrene with some ascending [[cellulitis]] <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| </gallery>
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| </div>
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| ===Wet gangrene===
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| Wet gangrene 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. In wet gangrene, the tissue is infected by saprogenic microorganisms (Bac.perfringes, fusiformis, putrificans, etc.), which cause tissue to swell and emit a fetid 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 toxic products formed by bacteria are absorbed causing systemic manifestation of [[septicemia]] and finally death. Macroscopically, the affected part is edematous, soft, putrid, rotten and dark. The darkness in wet gangrene occurs due to the same mechanism as in dry gangrene.
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:AUTOAMPUTATE1.JPG|Diabetic with severe infection and loss of toes - wet gangrene in center. <br> (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)
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| </gallery>
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| </div>
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| ===Gas gangrene===
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| {{main|Gas gangrene}}
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| Gas gangrene is a bacterial infection that produces gas within tissues. It is a deadly form of gangrene usually caused by ''[[Clostridium perfringens]]'' bacteria. Infection spreads rapidly as the gases produced by bacteria expand and infiltrate healthy tissue in the vicinity. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency.
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| 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 [[Streptococcus|streptococci]]). These environmental bacteria may enter the muscle through a wound and subsequently proliferate in necrotic tissue and secrete powerful toxins. These toxins destroy nearby tissue, generating gas at the same time. A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen and 16.1% oxygen was reported in one clinical case.<ref>{{cite journal |author=Chi CH, Chen KW, Huang JJ, Chuang YC, Wu MH |title=Gas composition in Clostridium septicum gas gangrene |journal=J. Formos. Med. Assoc. |volume=94 |issue=12 |pages=757–9 |year=1995 |month=December |pmid=8541740 |doi= |url=}}</ref>
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| Gas gangrene can cause [[necrosis]], gas production, and [[sepsis]]. Progression to [[bacteremia|toxemia]] and [[septic shock|shock]] is often very rapid.
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| ==Specific gangrenes==
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| *[[Noma (disease)|Noma]] is a gangrene of the face.
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| *[[Necrotizing fasciitis]] affects the deeper layers of the skin.
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| *[[Fournier gangrene]] usually affects the male genitals.
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| ==Treatment== | | ==Treatment== |
| | [[Gangrene medical therapy|Medical Therapy]] | [[Gangrene surgery|Surgery]] | [[Gangrene primary prevention|Primary Prevention]] | [[Gangrene secondary prevention|Secondary Prevention]] | [[Gangrene cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Gangrene future or investigational therapies|Future or Investigational Therapies]] |
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| As early as 1028, when antibiotics had not yet been discovered, [[fly]] [[maggot]]s were commonly used to treat chronic wounds or [[ulcer]]s to prevent or arrest necrotic spread, as some species of [[maggot]]s consume only dead flesh, leaving nearby living tissue unaffected. This practice largely died out after the introduction of [[antibiotics]] and [[enzyme]] to the range of treatments for wounds. Recently, however, [[maggot therapy]] has regained some credibility and is sometimes employed with great efficacy in cases of chronic tissue necrosis.
| | ==Case Studies== |
| | [[Gangrene case study one|Case #1]] |
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| In modern times treatment is usually surgical [[debridement]], and excision with amputation is necessary in many cases. Antibiotics alone are not effective because they do not penetrate ischemic muscles sufficiently.
| | ==Related Chapters== |
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| ==See also==
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| *[[Wound healing]] | | *[[Wound healing]] |
| *[[Liquefactive necrosis]] | | *[[Liquefactive necrosis]] |
| *[[Bedsore]] | | *[[Bedsore]] |
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| ==References==
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| {{Reflist|2}}
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| {{Circulatory and respiratory system symptoms and signs}} | | {{Circulatory and respiratory system symptoms and signs}} |
| {{Symptoms and signs}} | | {{Symptoms and signs}} |
| {{SIB}}
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| | | [[Category:Medical signs]] |
| [[Category:Signs and symptoms]] | | [[Category:Signs and symptoms]] |
| [[Category:Surgery]] | | [[Category:Surgery]] |
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| [[Category:Intensive care medicine]] | | [[Category:Intensive care medicine]] |
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| [[ar:غنغرينة]]
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| [[bg:Гангрена]]
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| [[ca:Gangrena]]
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| [[cs:Gangréna]]
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| [[da:Gangræn]]
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| [[de:Gangrän]]
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| [[et:Gangreen]]
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| [[es:Gangrena]] | | [[es:Gangrena]] |
| [[eo:Gangreno]]
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| [[fa:قانقاریا]]
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| [[fr:Gangrène]] | | [[fr:Gangrène]] |
| [[io:Gangreno]]
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| [[is:Kolbrandur]]
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| [[it:Cancrena]]
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| [[he:נמק]]
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| [[nl:Gangreen]]
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| [[no:Koldbrann]]
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| [[pl:Zgorzel]] | | [[pl:Zgorzel]] |
| [[pt:Gangrena]] | | [[pt:Gangrena]] |
| [[qu:Kawsaykuq tantalli ismusqa]]
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| [[ru:Гангрена]] | | [[ru:Гангрена]] |
| [[scn:Cancrena]]
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| [[fi:Kuolio]]
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| [[sv:Kallbrand]]
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| [[tr:Kangren]] | | [[tr:Kangren]] |
| [[uk:Гангрена]]
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| [[wa:Grangrin]]
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| [[zh:坏疽]] | | [[zh:坏疽]] |
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