On March 17th every year, millions of people gather to join in the celebration of Saint Patrick’s Day. St. Patrick is considered the patron saint of Ireland and is credited with bringing Christianity there. March 17th was the day of St. Patrick’s death. For the devoutly religious, church services and a temporary reprieve from Lenten promises is the perfect way to celebrate. For the rest of us, it’s pinching people not wearing green clothing and drinking oddly-colored green beer. In fact, I only own one green shirt and I keep it solely for the purpose of wearing on St. Patrick’s Day.
Although it is an uncommon condition, one type of green you don’t want to be seen wearing is gangrene. Gangrene arises from restricted blood flow, usually to the lower extremities. The skin and underlying tissue are not receiving adequate amounts of oxygen and they slowly begin to necrotize (die). This is a serious and potentially life threatening ailment. Gangrene is generally not something that will “just spring up”. There are risk factors and warning signs and knowing these will help you avoid complications.
WHO IS AT RISK?
Gangrene has two primary causes: lack of blood supply and infection. Lack of blood supply can develop from many pre-existing conditions including: diabetes, atherosclerosis (blood vessel disease), vascular disease, Reynaud’s disease, smoking, obesity, injury, immunosuppression, and certain medications. Gangrene resulting from infection usually occurs after a bad injury that isn’t treated properly or from a wound following a medical procedure or as a complication of another injury such as a burn or frostbite.
TYPES OF GANGRENE
There are two major types of gangrene and a couple of more rare ones. The most common type is dry gangrene. This type of gangrene takes days or even months to develop and generally stems from a preexisting vascular condition. Signs of dry gangrene vary with severity and location, but generally start with a cool and numb feeling in the affected area. Skin will change from healthy to brown, blue, or black accompanied by evidence of excessive dryness and shrinkage. Eventually the body will slough off the affected area (meaning the tissue will fall off completely). While fatalities from dry gangrene are rare, it is still important to get treatment immediately because as tissue death progresses, more extreme measures may have to be taken to correct it. It is also not uncommon for dry gangrene areas to become infected and progress to wet gangrene, which is much worse.
“Wet (also sometimes termed "moist") gangrene is the most dangerous type of gangrene because if it is left untreated, the patient usually develops sepsis and dies within a few hours or days. Wet gangrene results from an untreated (or inadequately treated) infection in the body where the local blood supply has been reduced or stopped by tissue swelling, gas production in tissue, bacterial toxins, or all of these factors in combination.” (http://www.medicinenet.com/gangrene/article.htm) Early symptoms of wet gangrene start with aching pain and swelling. A foul smelling discharge or pus will appear around ulcerations and the dying tissue takes on a moist, black appearance. Infection can also lead to gas buildup inside the body tissues, so you may feel a crackling under the skin where gas is trapped.
HOW IS GANGRENE DIAGNOSED?
If you see any discoloration of the skin accompanied by numbness, get yourself to the doctor right away. If dry gangrene is suspected, your doctor will perform an angiography, which will show them how much blood is flowing in the affected tissues. For wet gangrene, blood cultures are used to determine the type of infection and MRIs are used to show the extent of damaged tissue or spread of gas. Removal (debridement or amputation) of the affected area is often necessary along with antibiotic treatment. Wounds can also be treated with hyperbaric oxygen treatment in conjunction to other methods.
HOW DO I AVOID GANGRENE?
Avoiding gangrene is generally easy. For diabetics this means maintaining steady glucose levels and checking your feet regularly. This should be a daily activity for those with vascular conditions affecting the feet. If you have any injury to an extremity (such as your toes), especially if it is a burn or cut, get treatment right away. Preventing infection is an important step to preventing gangrene. In short, as I have said many times before, just pay attention to your feet.
If you suspect that you have signs of gangrene, contact our doctors immediately to make an appointment. Early diagnosis and treatment is important to reduce complications and speed healing time.