Gangrene classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.

Overview

There are three main types of gangrene which include wet, dry, and gas gangrene. Sometimes, gangrene is also classified according to its site.

Classification

There are three main types of gangrene which include wet, dry, and gas gangrene. Sometimes, gangrene is also classified according to its site. Table 1 summarizes the classification of gangrene.

Table 1. Classification of Gangrene.

Classification	Example	Description	Images
Based on Type	Dry Gangrene	Dry gangrene refers to a dehydrated necrotic tissue brought about by worsening ischemia distal to the occlusion of arteries. This is usually a worsening condition of peripheral artery disease.	Dry gangrene on the right foot of a patient with peripheral artery disease. (Image courtesy of Wikipedia)
	Wet Gangrene	This is an infection of a compromised tissue due to poor venous or arterial flow. Most cases of wet gangrene are seen in lower extremities, where pool of gravity leading to edema is most likely to happen. However, there are some instances that wet gangrene is seen in oral and genitourinary areas. People with diabetes are at high-risk to have this infection, which is attributed to hyperglycemia and poor wound healing.	Wet gangrene seen on a patient with diabetes and is suffering with severe infection and loss of toes (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA.)
	Gas Gangrene	Gas gangrene involves the production of gas by some bacteria within the body tissues causing infections. It is a deadly form of gangrene usually caused by Clostridium perfringens bacteria. Infection spreads very fast brought about by rapid expansion of gases produced by Clostridium perfringens, thereby infiltrating the surrounding healthy tissues. Because of its ability to quickly spread to surrounding tissues, gas gangrene should be treated as a medical emergency. Gas gangrene often causes gas production, necrosisand sepsis. Rapid progression to bacteremia and septic shock is often noted.	Gas gangrene on the right leg and pelvis of a patient with palpable crepitus, swelling, bullae, and discoloration. (Image courtesy of Wikipedia.)
Based on Site	Gangrene of the skull	Gangrene of the skull is a dark-colored area transitioning to a yellowish-off white color. This happens after a fracture, and it is considered a deadly condition once it becomes purulent, with bleb-formation on the tongue. Swelling, spasm on one side of the body, and exfoliation are the usual clinical manifestations of this condition.	Gangrenous abscess extending into the skull. (Image courtesy of National Library of Medicine.)
	Gangrene of the face	Noma is the term used to refer to the gangrene of the face.	Mucous membranes of the mouth are destroyed. (Image courtesy of A.D.A.M., Inc. thru National Library of Medicine.) Periorbital gangrene on the face. (Image courtesy of National Library of Medicine.)
	Gangrene of the jaw	Tooth fracture and inflammation cause gangrene of the jaw.
	Gangrene of the extremities	There are several possible causes of gangrene of the extremities. These include: Old ulcer or lesion in the affected part Careless positioning after prolonged bed rest Improper bandage application on the extremity Clinical manifestations include: "Sticky serum" appearance Chills Fever Difficulties in speech Convulsions Trembling Sweating Pain Hiccoughs Ecchymoses Signs that a gangrene is about to develop: Hardness and paleness. Signs that a gangrene will not develop: Livid after the ecchymosis, greenish or yellowish, and soft.	Digital gangrene of the upper extremities. (Image courtesy of National Library of Medicine.) Digital gangrene of the lower extremities due to Streptococcus pyogenes. (Image courtesy of National Library of Medicine.)
	Gangrene of the ribs	Gangrene of the ribs can bring about hemoptysis, coughs, and abscesses.
	Gangrene of the skin	Necrotizing fasciitis affects the deeper layers of the skin.	Necrotizing fasciitis in an immunocompromised patient. (Image courtesy of National Library of Medicine.)
	Gangrene of the genitals	Fournier's gangrene usually affects the male genitals.	Patient with a Fournier's gangrene and Type 2 Diabetes Mellitus. (Image courtesy of National Library of Medicine.)