Gangrene is a complication of necrosis characterized by the decay of body tissues. Results from ischemia, infection, or trauma (or a combination of these processes).
Two main categories: infectious gangrene (which includes necrotizing fasciitis and gas gangrene) and ischemic gangrene (which can arise from arterial or venous obstruction).
Risk factors include diabetes, smoking, atherosclerosis, renal disease, drug and alcohol abuse, malignancy, trauma or abdominal surgery, contaminated wounds, malnutrition, hypercoagulable states, prolonged use of tourniquets, and community-acquired MRSA.
Successful treatment of infectious gangrene requires early recognition and a combination of aggressive surgical debridement, appropriate intravenous antibiotics, and intensive supportive care.
Ischemic gangrene requires revascularization for obstruction and thromboembolism, along with optimal treatment of any underlying disease. Measures to prevent superimposed infection must also be performed.
Prognosis is highly variable, but can involve significant morbidity and mortality.
Gangrene is a complication of necrosis characterized by the decay of body tissues. There are two major categories: infectious gangrene (wet gangrene) and ischemic gangrene (dry gangrene). The condition may result from ischemia, infection, or trauma (or a combination of these processes). Ischemia may result from either arterial or venous compromise, and may be an acute or chronic process (or a combination of both). Critically insufficient blood supply is the most common cause of gangrene, and is often associated with diabetes and long-term smoking.
History and exam
- diabetes mellitus
- atherosclerosis (ischemic gangrene)
- smoking (ischemic gangrene)
- renal disease
- drug and alcohol abuse
- trauma or abdominal surgery (infectious gangrene)
- contaminated wounds (infectious gangrene)
- immunosuppression (infectious gangrene)
- malnutrition (infectious gangrene)
- hypercoagulable states (ischemic gangrene)
- prolonged application of tourniquets (ischemic gangrene)
- community-acquired MRSA
- surgical exploration and skin biopsy
- CT angiography
- magnetic resonance angiography (MRA)
- CT chest and abdomen
- antinuclear antibodies (ANA), lupus anticoagulant, anticardiolipin, and anti beta2 glycoprotein-1 antibodies
- serum cold agglutinins
- serum cryofibrinogens
- plasma cryoglobulin
Jason Jacob, MD
Department of Medicine
JJ declares that he has no competing interests.
Robert J. Gionfriddo, DO
Department of Medicine
RJG declares that he has no competing interests.
Dr Jason Jacob and Dr Robert J. Gionfriddo would like to gratefully acknowledge Dr William Tennant, Dr Badr Aljabri, Dr Mohammed Al-Omran, Dr Jose Contreras-Ruiz, and Dr Iris Galvan-Martinez, the previous contributors to this topic.
WT, BA, MA, JC, and IG declare that they have no competing interests.
Meryl Davis, MD
Consultant Vascular Surgeon
Royal Free Hampstead
MD declares that she has no competing interests.
Charles Fox, MD
Department of Surgery
Walter Reed Army Medical Center
CF declares that he has no competing interests.
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