What is gangrene? From vascular occlusion to infection
Risk of gangrene
(Introduction and Management of Gangrene)
Diabetic foot ulcers (DFUs) may further lead to gangrene, which is the ischemic necrosis of tissue resulting from inadequate blood supply, infection, or injury1,2. In addition, gangrene can be divided into two forms—dry gangrene and wet gangrene, each with distinctly different characteristics1,2.
Forms of Gangrene
- Dry Gangrene：
When tissue ischemic necrosis occurs, if the site of gangrene is not infected, the tissue may become dry and black, presenting a relatively desiccated and aseptic state1.
- Wet Gangrene：
If the gangrenous tissue site is infected, the tissue may rot or become inflamed, causing swelling or blisters, resulting in wet gangrene1.
Causes of Gangrene
- Peripheral Artery Disease (PAD)
About half of the patients with DFUs also suffer from PAD2. Patients with PAD are prone to developing tiny blood clots or embolisms in their vessels, causing the vessels to become increasingly narrow or blocked. Obstruction of blood flow in the lower limbs can lead to ischemic tissue necrosis in their feet3.
- Infection
If the gangrenous tissue is infected, it may rot or become inflamed, referred to as wet gangrene. The inflammatory response caused by the infection within the tissue may lead to an increase in internal pressure, which hinders the blood flow through the area, accelerating the deterioration of the tissue into ischemic necrosis4.
Management and Treatment Strategies of Gangrene
Once gangrene occurs, it usually indicates that the patient's DFU is more severe, and the risk of amputation significantly increases5. Therefore, they should consider hospitalization treatment as a priority4. If the patient also has PAD, treatment for PAD should be considered to prevent the worsening of gangrene; for wet gangrene combined with infection, consideration should be given to whether drainage or revascularization surgery is needed4.
Want to learn about the treatment options for diabetic foot ulcers?
"DFU Treatment Guide: The Three-Step Approach of Wound Care, Offloading, and Education"
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Reference：
- van Netten JJ et al. Diabetes Metab Res Rev. 2023;e3654.
- Armstrong DG et al. JAMA. 2023;330(1):62-75.
- Rosyid FN et al. Int J Med Sci. 2017 Oct;5(10):4206-4213.
- Senneville É et al. Diabetes Metab Res Rev. 2023;e3687.
- Lin C et al. PLoS One. 2020;15(9):e0239236.