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Treatments and drugs
By Mayo Clinic staffTissue that has been damaged by gangrene can't be saved, but steps can be taken to prevent gangrene from progressing. These treatments include:
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Surgery. Your doctor removes the dead tissue, which helps stop gangrene from spreading and allows healthy tissue to heal. If possible, your doctor may repair damaged or diseased blood vessels in order to increase blood flow to the affected area.
A skin graft is a type of reconstructive surgery that may be used to treat gangrene that's caused extensive damage to your skin. During a skin graft, your doctor removes healthy skin from another part of your body — usually a place hidden by clothing — and carefully spreads it over an affected area. The healthy skin may be held in place by a dressing or by a couple of small stitches. A skin graft can only be done if an adequate blood supply has been restored to the damaged skin.
In severe cases of gangrene, an affected body part, such as a toe, finger or limb, may need to be surgically removed (amputated). In some cases, you may be fitted with an artificial limb (prosthesis).
- Antibiotics. Antibiotics given through a vein (intravenous) may be used to treat gangrene that's become infected.
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Hyperbaric oxygen therapy. In this type of therapy, you'll be situated in a special chamber, which usually consists of a padded table that slides into a clear plastic tube. The chamber is pressurized with pure oxygen, and the pressure inside the chamber will slowly rise to about two and a half times normal atmospheric pressure.
Hyperbaric oxygen therapy may be used to treat gas gangrene. Under increased pressure and increased oxygen content, your blood is able to carry greater amounts of oxygen. Blood rich in oxygen inhibits the growth of bacteria that thrive in the absence of oxygen and helps infected wounds heal more easily.
Hyperbaric oxygen therapy for gas gangrene generally lasts about 90 minutes. You may need up to three treatments on the first day of hyperbaric oxygen therapy, followed by twice-daily treatments for up to five days. During the therapy, your ears might pop as they adjust to the increased pressure. Afterward, you may feel lightheaded and tired.
Other treatments for gangrene may include supportive care, including fluids, nutrients, and pain medication to relieve your discomfort.
Prognosis
Generally, people who have dry gangrene have the best prognoses because dry gangrene doesn't involve a bacterial infection and spreads more slowly than do the other types of gangrene. However, when infected gangrene is recognized and treated quickly, the probability of recovery is good.
Older people, those who are immunocompromised, those who have underlying conditions, such as diabetes, atherosclerosis or some cancers, and those who have advanced cases of gangrene by the time that they seek treatment are most likely to have complications from gangrene.
- Meislin HW, et al. Soft tissue infections. In: Marx JA, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006. http://www.mdconsult.com/das/book/body/141947879-3/849444931/1365/420.html#4-u1.0-B0-323-02845-4..50140-2_7293. Accessed June 4, 2009.
- Stevens DL. Necrotizing fasciitis, gas gangrene, myositis and myonecrosis. In: Cohen J, et al. Infectious Diseases. 2nd ed. St. Louis, Mo.: Mosby; 2004. http://www.mdconsult.com/das/book/body/141947879-5/849445124/1209/32.html#4-u1.0-B0-323-02407-6..50012-X_334. Accessed June 4, 2009.
- Stevens DL. Necrotizing infections of the skin and fascia. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Abrahamian FM, et al. Management of skin and soft-tissue infections in the emergency department. Infectious Disease Clinics of North America. 2008;22:89.
- May AK. Skin and soft tissue infections. Surgical Clinics of North America. 2009;89:403.
- Kaide CG. Hyperbaric oxygen: Applications in infectious disease. Emergency Medicine Clinics of North America. 2008;26:571.
- Neschis DG. Clinical manifestations and evaluation of chronic critical limb ischemia. http://www.uptodate.com/home/index.html. Accessed June 4, 2009.
- Sepsis and septic shock. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec06/ch068/ch068a.html. Accessed June 4, 2009.
- Anderson DJ, et al. Skin and soft tissue infections in older adults. Clinics in Geriatric Medicine. 2007;23:595.
- Sheps SG (expert opinion). Mayo Clinic, Rochester, Minn. June 6, 2009.
