Gangrene classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Three main types of gangrene in clude wet, dry and gas gangrene. Sometimes it can be classified according to its site.

Types of gangrene

Dry gangrene

Dry gangrene begins at the distal part of the limb due to ischemia and often occurs in the toes and feet of elderly patients due to arteriosclerosis. Dry gangrene spreads slowly until it reaches the point where the blood supply is inadequate to keep tissue viable. The line of separation usually brings about complete separation with eventual falling off of the gangrenous tissue if it is not removed surgically. The early signs of dry gangrene are a dull ache and sensation of coldness in the affected area along with pallor of the flesh. If caught early, the process can sometimes be reversed by vascular surgery. However, if necrosis sets in, the affected tissue must be removed just as with wet gangrene.

• 
  Diabetic ulceration with central "dry" gangrene and toward the edges wet gangrene with some ascending cellulitis
  (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

Wet gangrene

Wet gangrene occurs in naturally moist tissue and organs such as the mouth, bowel, lungs, cervix, and vulva. Bedsores occurring on body parts such as the sacrum, buttocks and heels—although not necessarily moist areas—are also categorized as wet gangrene infections. The darkness in wet gangrene occurs due to the same mechanism as in dry gangrene.

• 
  Diabetic with severe infection and loss of toes - wet gangrene in center.
  (Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)

Gas gangrene

Main article: Gas gangrene

Gas gangrene is a bacterial infection that produces gas within tissues. It is a deadly form of gangrene usually caused by Clostridium perfringens bacteria. Infection spreads rapidly as the gases produced by 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 can cause necrosis, gas production, and sepsis. Progression to toxemia and shock is often very rapid.

Specific gangrenes

• Noma is a gangrene of the face.
• Necrotizing fasciitis affects the deeper layers of the skin.
• Fournier gangrene usually affects the male genitals.