Gangrene

Gangrene is a condition where the body's tissues die due to not getting enough blood supply. This condition generally occurs in the legs, toes, or fingers, but can also occur in the muscles and organs in the body.

Gangrene is a serious condition that can lead to amputation and death. This condition is often found as a complication of diseases that cause damage to blood vessels and blood flow, such as diabetes or atherosclerosis .

Causes of Gangrene

Basically, gangrene is caused by stopping or reducing blood flow to body tissues. This makes the body's tissues deprived of oxygen and nutrients, thus causing the cells in the body's tissues to die.

In addition to lack of blood flow, gangrene can also occur due to the following conditions:

Serious injury

Serious injuries, such as injuries from a severe traffic accident, burns, or frostbite , can damage blood vessels and cause blood flow to stop. In addition, serious injuries can also cause open wounds that are prone to infection.

Infection

In general, infection in wounds that are left too long can cause gangrene. Gangrene can start as a surgical wound or a large open wound. However, small open wounds can also cause gangrene if not treated properly.

Certain bacterial infections, eg Clostridi u um perfringens , can produce toxins that can numb tissue and release gas. This condition will cause gas gangrene.

In some cases, gangrene can also occur due to improper handling of injuries, especially injuries such as fractures or sprains. Handling without a thorough medical examination can cause damage to blood vessels which can lead to gangrene.

Gangrene risk factors

Gangrene can happen to anyone. However, this condition is more often experienced by diabetics, especially those whose diabetes is not well controlled.

High blood sugar levels experienced by diabetics can damage the nerves, especially the nerves at the ends of the hands and feet, causing numbness in that part ( peripheral neuropathy ). This condition makes diabetics susceptible to unnoticed injuries, so they are at risk of infection and develop into gangrene.

High blood sugar levels can also block blood flow to the tips of the hands and feet, reducing the supply of blood and cells that fight infection in these parts of the body. This condition causes the wound to become more difficult to heal and susceptible to infection, and the risk of becoming gangrene.

Apart from suffering from diabetes, several conditions that can also increase a person's risk of experiencing gangrene are:

• Have a smoking habit
• Suffering from vascular diseases, such as peripheral arterial disease, atherosclerosis, and Raynaud's syndrome
• Have untreated claudication
• Having excess body weight (obesity)
• Have a weakened immune system as a result of a health condition, such as having HIV/AIDS , or as a result of treatment, such as receiving chemotherapy
• Undergo surgery
• Excessive alcohol consumption in the long term
• Using drugs in the form of injections
• Suffering from COVID-19
• Over 60 years old

In some cases, gangrene occurs in people who are healthy and without the above conditions or risk factors. The cause of its occurrence is not known with certainty.

Gangrene Symptoms

Symptoms of gangrene vary widely, depending on the underlying cause. Gangrene can affect any part of the body, but generally occurs in the feet or hands.

Symptoms of gangrene can be divided into external gangrene and internal gangrene. Symptoms of external gangrene are visible on the surface of the skin, while symptoms of internal gangrene occur in the body.

External gangrene

Due to a lack of blood supply, the skin may experience common symptoms, such as:

• The skin feels cold to the touch
• Skin thinning or tightening (shiny)
• The skin is experiencing hair loss
• Severe pain or numbness

Based on the appearance, external gangrene can be divided into several types, namely:

• Dry
  gangrene Dry gangrene is characterized by dry, wrinkled skin. Skin color also changes to brown, purple, and black. Symptoms occur slowly and rarely cause infection.

• Wet
  gangrene Wet gangrene can be characterized by skin that is swollen, blistered, and looks wet with pus. This type is often due to infection and can spread fairly quickly to surrounding tissues.

• Gas
  gangrene Gas gangrene usually affects muscle tissue. In the early stages, the skin of people with gas gangrene looks normal. But over time, the skin will look pale and then turn reddish purple. After that, the skin may appear bubbly due to the gas that is formed.

Symptoms of external gangrene can also be distinguished by its location. The explanation is as follows:

• Fournier
  's gangrene This gangrene attacks the genital area or genitals, and most sufferers are men. This condition generally occurs due to an infection in the pubic area or urinary tract. Fournier's gangrene can be characterized by symptoms such as fever, swelling and pain in the genitals, and an unpleasant odor in the genitals.

• Meleney
  's gangrene Meleney's gangrene attacks surgical scars. This condition is a type that is classified as rare and includes complications of surgery. Meleney's gangrene is characterized by fever and pain in the surgical wound that does not go away for 1-2 weeks postoperatively.

Internal gangrene

Internal gangrene causes no skin symptoms. The symptoms of internal gangrene will depend on the organ that has been damaged by the lack of blood supply. Nevertheless, there are some common symptoms experienced by sufferers of internal gangrene:

• Persistent low-grade fever
• Feeling weak and not feeling well
• Pain in the problematic part of the internal organs

The bacteria that cause gangrene infection can also spread throughout the body and cause a condition called sepsis . This condition can cause a decrease in blood pressure, high fever or low body temperature, heart rhythm disturbances, shortness of breath, and decreased consciousness.

When to see a doctor

Gangrene is a serious condition and requires emergency treatment. Therefore, immediately see a doctor if you experience symptoms that do not improve, such as:

• Prolonged fever
• Changes in the skin, such as changes in color, shape, or temperature, that don't go away
• Have a wound that emits fluid and smells bad
• Severe pain in the area of ​​​​the surgical scar, if after undergoing surgery

Gangrene Diagnosis

To diagnose gangrene, the doctor will begin the examination by asking about the symptoms and complaints experienced, as well as the patient's medical history. Next, the doctor will carry out a physical examination, especially in the area of ​​the wound that is experiencing symptoms.

To confirm the diagnosis, the doctor will also perform further examinations with the following tests:

• Blood test , to detect the occurrence of infection by looking at the number of white blood cells or detecting the presence of bacteria in the blood
• Fluid and tissue culture, to determine the bacteria that cause gangrene, such as Clostridium perfringens, by taking fluid and tissue samples
• Radiological tests, with X-rays , CT scans, or MRIs, to see the condition of the internal organs, and find out how far the gangrene has spread
• Surgery, to find out more clearly how widespread gangrene is in the body

Gangrene Treatment

Gangrene treatment is generally done by removing dead tissue to prevent gangrene and infection from developing further. The doctor will provide treatment based on the severity and condition of the patient's health. Some of the treatments that can be given are:

Drugs

Doctors can give antibiotics through an IV or in the form of oral medications to treat gangrene caused by a bacterial infection. In addition, the doctor can also give pain medication to relieve pain or discomfort that the patient may be experiencing.

Operation

The surgical procedure is carried out based on the type of gangrene and its severity. Patients may undergo more than one operation if the gangrene is getting worse. Some of the operations that can be performed are:

• Debridement
  This operation is performed to remove dead tissue, so that the spread of gangrene can be prevented and allow healthy tissue around it to recover. This surgery can also repair blood vessels so that blood flow to the area affected by gangrene becomes smoother.

• Skin grafting (reconstructive surgery)
  This surgery is performed to repair damaged skin with healthy skin. Healthy skin will be taken from another area, then attached or grafted to the area affected by gangrene. This operation can only be done if the blood flow in the area experiencing gangrene has returned to normal.

• Amputation
  This operation is performed in cases of severe gangrene. Amputation is done by removing the part of the body affected by gangrene.

Therapy

Apart from drugs and surgery, doctors may also recommend hyperbaric oxygen therapy to treat gangrene, especially for patients with wet gangrene.

This therapy is done to increase the amount of oxygen in the blood. In the process, the patient will be placed in a room such as a tube containing high-pressure oxygen gas.

Strong oxygen tension will make the blood carry more oxygen, thereby slowing the growth of bacteria and helping the wound to heal quickly.

Gangrene Complications

Gangrene that is not treated immediately can cause complications caused by the expansion of the affected area. Some of these complications are:

• Sepsis
• Widening scars
• Long healing process
• Disability due to amputation

Gangrene Prevention

Gangrene prevention can be done with the following steps:

• For diabetics, be sure to always pay attention to the condition of the feet to detect if there are wounds or signs of infection, such as swelling, redness, and discharge. Also try to regulate blood sugar levels.
• If you are overweight, try to lose weight . Ideal body weight can reduce the risk of diabetes and narrowing of blood vessels.
• Stop smoking or avoid exposure to secondhand smoke.
• Prevent infection by always cleaning open wounds with soap and water, and keeping the wound dry until it heals.
• Be aware of very cold temperatures, for example during winter abroad or at the top of high mountains, because frostbite can occur .