Infection spreads rapidly as the gases produced by the 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. Gas gangrene is caused by bacterial exotoxin-producing clostridial species, which are mostly found in soil, and other anaerobes such as Bacteroides and anaerobic streptococci. These environmental bacteria may enter the muscle through a wound and subsequently proliferate in necrotic tissue and secrete powerful toxins that 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.Gas gangrene can cause necrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid. Other types
Necrotizing fasciitis, also known as hemolytic streptococcal gangrene, is a very rare infection that spreads deep into the body along tissue planes. It is characterized by infection with S.pyogenes, a gram-positive cocci bacteria. Noma is a gangrene of the face common in Africa and Asia, with 99% of cases occurring there, whereas the disease is practically non-existent in other continents. Fournier gangrene is a type of necrotizing fasciitis that usually affects the genitals and groin. Venous limb gangrene may be caused by heparin-induced thrombocytopenia and thrombosis. Severe mesenteric ischemia may result in gangrene of the small intestine. Severe ischemic colitis may result in gangrene of the large intestine. Treatment
Treatment varies based on the severity and type of gangrene.
Lifestyle
Exercises such as walking and massage therapy may be tried. Medication
Medications may include pain management, medications that promote circulation in the circulatory system and antibiotics. Since gangrene is associated with periodic pain caused by too little blood flow, pain management is important so patients can continue doing exercises that promote circulation. Pain management medications can include opioids and opioid-like analgesics. Since gangrene is a result of ischemia, circulatory system management is important. These medications can include antiplatelet drug, anticoagulant, and fibrinolytics. As infection is often associated with gangrene, antibiotics are often a critical component of its treatment. The life-threatening nature of gangrene requires treatment with intravenous antibiotics in an inpatient setting. Antibiotics alone are not effective because they may not penetrate infected tissues sufficiently. Surgery
Surgical removal of all dead tissue, however, is the mainstay of treatment for gangrene. Often, gangrene is associated with underlying infection, thus the gangrenous tissue must be debrided to hinder the spread of the associated infection. The extent of surgical debridement needed depends on the extent of the gangrene and may be limited to the removal of a finger, toe, or ear, but in severe cases may involve a limb amputation.Dead tissue alone does not require debridement, and in some cases, such as dry gangrene, the affected part falls off (autoamputates), making surgical removal unnecessary. Waiting for autoamputation, however, may cause health complications as well as decreased quality of life.After the gangrene is treated with debridement and antibiotics, the underlying cause can be treated.