Introduction[edit | edit source]
Gangrene is a condition characterized by the death of body tissues due to the loss of blood. It can be caused by illness, injury, or infection and usually happens in extremities like fingers, toes, and limbs. Gangrene can also occur in organs and muscles .
Symptoms[edit | edit source]
Signs and symptoms of gangrene may include the following: 
- Skin discoloration which can be from pale to blue, purple, black, bronze, or red, depending on the type of gangrene you have
- Sudden, severe pain followed by a feeling of numbness
- A foul-smelling discharge leaking from a sore
- Thin, shiny skin, or skin without hair
- Fever and feeling unwell depending on the type of gangrene
A few symptoms can be red flags and begin before gangrene starts:
- Rest pain
- Pallor of extremities on elevation
- Poor capillary filling
- Thickening or scaling of the skin
Types of Gangrene[edit | edit source]
There are two main types of Gangrene:
1. Dry Gangrene
Dry gangrene is frequently observed among patients who have vascular disease, diabetes, and autoimmune diseases. It usually affects the hands and feet and happens when there is poor blood circulation to a certain area. Therefore, the tissue that dries up changes color and can either turn brown, purplish-blue, or black before the tissue can fall off. There is no infection associated with dry gangrene, but it can lead to wet gangrene if infected. Dry gangrene has a slow progression.
2. Wet Gangrene
Wet gangrene is a condition that involves infection and affects moist tissues such as respiratory tissues, oral tissues, cervix, and vulva. Swelling and blistering of the tissue are observed. An infection from wet gangrene can rapidly spread swift around the body. For a patient with a history of foot ulcer or tissue injury post diabetes or ischemia, the presence of drainage and edema should be a red flag for a wet gangrene diagnosis. Moreover, a thorough evaluation of the foot is needed to rule out any presence of deep foot abscess that comes with a plantar tenderness . Wet gangrene can progress from dry gangrene as the necrotic tissue becomes infected. In this case, it is therefore accompanied by an edematous and erythematous tissue surrounding the necrotic area .
The different types of Wet gangrene include:
- Internal gangrene affects internal organs such as the appendix or colon most of the time.
- Gas gangrene is a rare, dangerous, and life-threatening infection and is characterized by the presence of gas. If left untreated, gas gangrene can cause death within 48hrs .
- Fournier's gangrene is also a rare condition caused by an infection of the genital area. When the infection gets into the bloodstream, it is referred to as sepsis and is life-threatening. This type of gangrene affects more often men than women.
- Meleney's gangrene usually causes painful lesions on the skin one or two weeks post-surgery or minor trauma.
Risk Factors[edit | edit source]
- Severe injury or surgery
- High cholesterol
- Weakened immune system
- Injected medications or drugs
- Raynaud's Phenomenon
- Complications of COVID-19
Diagnosis[edit | edit source]
The diagnosis of gangrene is primarily clinical symptoms, with the medical history of the patient taken and physical examination done. Moreover, further tests can be done to confirm the diagnosis. These are:, 
- Blood Tests to look for bacteria or signs of infection.
- Imaging Tests such as MRI to specify the range of infection and CT scan offers a greater specificity for evaluating the extent of the disease to rule out any gas build up in the tissues.
- Angiography is a radiological test done to see the extent of ongoing or potential blood loss to tissue.
- Cultures to look for signs of bacteria or tissue death through a sample of fluid, blood or tissue. They help determine the appropriate antibiotic therapy to be given.
Treatment[edit | edit source]
Although the treatment of gangrene depends on its type, they all share the same general treatment goals which involve removal and treatment of dead tissue while focusing also on stopping the spread of infection and treating its cause.
The treatment of gangrene include: 
- Antibiotics to treat or prevent infection
- Hyperbaric Oxygen Therapy is used to treat Wet gangrene but can also be used to slow the growth of bacteria
- Surgery or debridement to remove dead tissue and avoid the spreading of the infection
Physiotherapy Management[edit | edit source]
The general goal here is to improve the functional status of the affected limb/limbs with:
- Exercises such as walking to improve circulation.
- Exercises to increase the range of motion (muscle flexibility and joint mobility).
- Buerger-Allen Exercises to increase proprioception and balance.
- Thermotherapy for wound healing.
- Massage Therapy.
More about the physiotherapy management of Diabetic Neuropathy can be found here.
Complications[edit | edit source]
- Low blood pressure
- Rapid heartbeat
- Shortness of breath
- Body temperature change
- Body pain and rash
- Cold, clammy and pale skin
- Blood infection leading to sepsis then Septic shock. This needs immediate treatment.
Prevention[edit | edit source]
Gangrene can be prevented by :
- Taking proper care of diabetes and diabetic foot
- Not smoking
- Keeping a healthy weight
- Preventing any infection
- Staying warm
Low Resources Health Settings[edit | edit source]
It is difficult to know the prevalence and incidence of gangrene in some countries since some patients especially in poor rural areas in Uganda, don't visit healthcare facilities and therefore die from gangrene and its complications. For those who manage to visit health centres, there are sometimes cases of misdiagnosis or diagnosis not properly recorded . Published data from a study done in Tanzania reported late surgical intervention after the onset of gangrene to prevent death . In their study, Richard et al., 2020, suggested that there are no estimates of the number of skin and soft tissue infections in Low and Middle-Income Countries (LMICs). Furthermore, they also suggested that Fournier's gangrene may occur as a result of untreated soft tissue infections .
The treatment and management of gangrene in LMICs may also differ from the one in the High-Income Countries (HICs) for the following reasons:
- There are few existing countries- or regional-level studies assessing the burden of necrotizing soft tissue infections in LMICs, with most studies retrospective, descriptive, hospital-level assessments or compilations of case reports.
- Shortage of trained personnel and material resources
Here are the recommendations from these studies :
- Early detection of gangrene for patients with risk factors for developing it.
- Early presentation of patients and prompt surgical intervention.
- Proper and adequate documentation of findings seen during surgical operations to reduce the under-reporting syndrome in developing countries. It includes patients’ diagnoses and health records.
References[edit | edit source]
- Gangrene. Available from: https://www.webmd.com/skin-problems-and-treatments/guide/gangrene-causes-symptoms-treatments ( Accessed, 11/09/2021).
- Gangrene. Available from: https://www.mayoclinic.org/diseases-conditions/gangrene/symptoms-causes/syc-20352567 (Accessed, 13/09/2021).
- Buttolph A, Sapra A. Gangrene. StatPearls [Internet]. 2021 Aug 11.
- Mahmood, Ahmed Hussein. (2021). Wet Gangrene.
- Gangrene. Available from: https://www.medicinenet.com/gangrene/article.htm (Accessed, 04/10/2021).
- Chennamsetty A, Khourdaji I, Burks F, Killinger KA. Contemporary diagnosis and management of Fournier’s gangrene. Therapeutic advances in urology. 2015 Aug;7(4):203-15.
- Dafiewhare OE, Agwu E, Ekanem P, Ezeonwumelu JO, Okoruwa G, Shaban A. A Review of Clinical Manifestations of Gangrene in Western Uganda. Gangrene Management-New Advancements and Current Trends. 2013 Mar 27.
- Abbas Z, Archibald L. Epidemiology of the diabetic foot in Africa. Medical science monitor. 2005 Aug 1;11(8):RA262-70.
- Rickard J, Beilman G, Forrester J, Sawyer R, Stephen A, Weiser TG, Valenzuela J. Surgical infections in low-and middle-income countries: a global assessment of the burden and management needs. Surgical infections. 2020 Aug 1;21(6):478-94.
- Mediklaas. Gangrene - An overview. Available from: https://www.youtube.com/watch?v=y75CLDEoEkQ [Accessed, 28/09/2021]
- Catalyst University. Differentiating Dry & Wet Gangrene. Available from: https://www.youtube.com/watch?v=x9lvXMUL78M [Accessed, 28/09/2021]