Gangrene

Overview

Gangrene happens when a part of the body stops getting enough blood. Blood carries oxygen and nutrients, so when it cannot reach the tissue, the cells start to die. It can affect the skin, muscle, and deeper tissue — most often in the toes, feet, fingers, hands, or limbs. Gangrene is serious, but it can be treated, especially when it is caught early. This is why it is always treated as an emergency.

Gangrene is not common in healthy people. It is much more common in people who have problems with their blood vessels, diabetes, or a serious injury or infection.

It can affect anyone, but it is seen most often in older adults with diabetes, heart or blood vessel disease, or kidney disease. It also affects people who smoke, people with a weakened immune system (for example from chemotherapy or some long-term illnesses), people who have had a severe injury, frostbite, or a badly infected wound, and people who inject drugs.

Symptoms

Common symptoms

• Skin that turns pale, then blue, purple, dark red, or black
• Skin that feels cold to the touch in the affected area
• Swelling, or a wound or sore that keeps getting worse
• Pain that may be severe at first, then later turns into numbness
• A sore, ulcer, or cut that does not heal
• Foul-smelling discharge from the area
• A crackling or popping feeling under the skin (this means gas is in the tissue)
• Fever, feeling generally very unwell, or confusion in more severe cases

Symptoms in children

• Gangrene is rare in children, but it can happen after a serious infection (for example a severe skin infection after chickenpox) or a bad injury.
• Watch for a wound that becomes very painful, swollen, or changes colour.
• A child may be clingy, very sleepy, or hard to wake, or may refuse to eat or drink.
• Trust your instincts — if a wound looks wrong or your child seems very unwell, get medical help straight away.

Symptoms in older adults

• Pain may be less obvious, so colour change and numbness can be the first signs.
• Foot ulcers and pressure sores that do not heal are common warning signs.
• New confusion or drowsiness can be a sign of serious infection.
• Cold, pale, or shiny skin on the feet or legs should always be checked.

Causes

Main causes

• Poor blood flow: narrowed or blocked arteries (often from peripheral arterial disease) mean less oxygen reaches the tissue.
• Serious infection: some bacteria cause severe, fast-spreading infections that cut off blood flow and destroy tissue.
• Serious injury: crush injuries, deep wounds, burns, or frostbite can damage blood vessels.
• Trapped or strangulated tissue: for example a twisted bowel or a strangulated hernia.
• Long-standing diabetes: high blood sugar damages small blood vessels and nerves, especially in the feet.

Risk factors

• Diabetes
• Peripheral arterial disease or other blood vessel disease
• Smoking
• High blood pressure or high cholesterol
• A weakened immune system (for example from chemotherapy, long-term steroid medicines, or some illnesses)
• Older age
• Kidney disease
• Heavy alcohol use
• Injecting drug use
• Frostbite or severe injuries
• Being immobile for long periods, which can cause pressure sores

When to see a doctor

See a doctor urgently if:

• Call your local emergency number if skin has turned black, a limb is suddenly cold and pale with severe pain, or you feel very unwell with a spreading, painful infection.
• See a doctor the same day if a wound, ulcer, or sore on your foot or hand is not healing, is getting more painful, or is changing colour.
• Get same-day advice if you have diabetes and notice any new problem with your feet — even a small cut or blister.

Book a routine appointment if:

• Ask your doctor about regular foot checks if you have diabetes or circulation problems.
• Talk to your doctor if you get cramping leg pain when walking, cold feet, or slow-healing cuts.
• Ask your pharmacist or nurse about wound care if a cut or graze is not settling within a few days.

Diagnosis

A doctor will ask about your symptoms and your health history, then look closely at the affected area. They will check the colour, temperature, and feeling in the skin, and feel for a pulse nearby. Gangrene is usually recognised on examination, and tests are used to find out how much tissue is affected and why it happened.

Tests that may be done

• Blood tests to look for infection and see how your body is coping
• A wound swab or small tissue sample to check for bacteria
• An ultrasound or Doppler scan to check blood flow
• CT or MRI scans to see how deep the problem goes
• An X-ray to look for gas in the tissue or damage to deeper structures
• Sometimes a small exploratory procedure to look at the tissue directly

What to expect at your appointment

You may be seen very quickly, sometimes in an emergency department. The team will focus first on whether the problem is spreading and whether you need urgent treatment. You may be asked to stay in hospital for monitoring, tests, and treatment. It can feel frightening, so it helps to bring someone with you if you can, and to ask the team to explain each step.

Treatment

Gangrene needs hospital treatment, and usually quickly. The goals are to remove dead tissue, treat any infection, and restore blood flow so healthy tissue can survive. The exact plan depends on where the gangrene is, how much tissue is affected, and what caused it.

Self-care at home

• Do not try to treat gangrene at home. Do not cut, scrub, or apply home remedies to dead or blackened skin.
• Keep the area clean and covered with a dry dressing while you get medical help.
• Do not walk on an affected foot or use an affected limb to lift things.
• Take all medicines exactly as prescribed, and go to all follow-up appointments.
• Stop smoking if you can — smoking narrows blood vessels and slows healing. Ask your doctor for support to quit.
• Check your feet every day if you have diabetes, and wear well-fitting shoes.

Medical treatments

Treatment usually combines several approaches. Dead tissue is removed by a surgeon, and antibiotics are given through a drip if there is an infection. The team may use procedures to improve blood flow to the area, such as widening a narrowed artery or creating a bypass around a blocked one. Good wound care and dressings are important, and some people are given extra oxygen in a special chamber to help tissue heal. Supportive care — fluids, pain relief, and close monitoring — is part of the plan too. The underlying cause, such as diabetes, is also treated.

When is surgery considered?

Surgery is usually needed to remove dead tissue (this is called debridement). If a large part of a limb has died and cannot be saved, amputation may be required. This is a big decision, and the team will discuss it with you carefully. If you are offered surgery, you will be told what it involves, the risks, and what recovery looks like.

Living with this condition

Recovery takes time. You may need help with walking, dressing, or cooking for a while, and you may have district nurse visits for wound care. Follow-up appointments are important so the team can check healing and catch any new problems early. If you have had an amputation, rehabilitation and a prosthesis (an artificial limb) can help you get back to daily life.

Lifestyle tips

• Stop smoking — this is one of the most important things you can do for your circulation.
• Keep blood sugar, blood pressure, and cholesterol within the range your doctor recommends.
• Check your feet, hands, and any healing wounds every day for changes.
• Wear well-fitting shoes and socks, and avoid very tight clothing or footwear.
• Keep feet warm and dry, and avoid walking barefoot if you have diabetes or poor circulation.
• Keep moving as much as your recovery allows — gentle activity helps circulation.

Diet and exercise

A balanced diet with plenty of vegetables, fruit, whole grains, and lean protein supports healing and helps control blood sugar and cholesterol. Ask your doctor or a dietitian for advice tailored to you. Gentle movement, such as short walks or physiotherapy exercises, helps blood flow and strength. Build up slowly and follow any advice from your care team.

Mental health and emotional wellbeing

Being diagnosed with gangrene, or facing surgery or the loss of a limb, can bring up fear, sadness, anger, and worry about the future. These feelings are normal and very common. Talk to your care team — they can refer you to a counsellor or psychologist. If you ever feel you cannot cope or have thoughts of harming yourself, reach out for crisis support right away: contact your local emergency number, your doctor, or a crisis line in your country.

Prevention

Many cases of gangrene can be prevented or at least caught early. The key is protecting your circulation and looking after any wound or infection quickly.

Vaccines

There is no vaccine for gangrene itself. However, staying up to date with recommended vaccinations — including flu and pneumonia vaccines if your doctor advises them, and diabetes-related checks — helps prevent infections and complications. Ask your doctor or pharmacist which vaccines are right for you.

Screening programmes

If you have diabetes, regular foot checks with a healthcare professional are an important form of screening. If you have circulation problems, your doctor may suggest checks such as blood pressure, cholesterol, and blood flow tests. These checks can spot problems before they cause serious damage.

Complications

If left untreated

• The dead tissue can spread, and infection can spread into the blood (this is called sepsis), which is life-threatening
• Loss of part of a limb (amputation) may be needed if treatment is delayed
• Long-term disability or reduced mobility
• Kidney and organ problems from severe infection
• In the most serious cases, gangrene can be fatal

Long-term outlook

With early treatment, many people recover and keep their limb. Some people need surgery or an amputation, and recovery takes time and rehabilitation — but support is available at every step. The outlook is best when gangrene is caught early and the underlying cause, such as diabetes or circulation disease, is managed well. Your care team can tell you what to expect in your situation.

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