Treatment for gangrene involves three main objectives:
- to remove the affected tissue with surgery (debridement)
- to prevent infection (or if infection is already present, to prevent it spreading)
- to address the conditions that led to gangrene developing
For example, if gangrene is caused by a poor blood supply, surgery may be used to repair damaged blood vessels. This is known as vascular surgery.
Debridement
Debridement is the surgical removal of the dead tissue that results from gangrene. Removing the dead tissue will prevent the gangrene from spreading, and allow healthy tissue to heal.
In severe cases of gangrene, where a whole body part – such as a finger, toe, or limb – is affected, amputation may be the only viable option.
Maggot therapy ('biotherapy')
Maggot therapy is a non-surgical method of debridement.
Certain types of maggot (those from fly larvae) are ideal for debridement because they feed on dead and infected tissue, but leave healthy tissue alone. They also help fight infection by releasing substances that kill bacteria, as well as stimulating the healing process.
Maggots used for maggot therapy are specially bred in a laboratory using sterilised eggs. During maggot therapy, the tiny maggots are put on to the wound and covered with gauze, under a firm dressing. After a few days, the dressing is cut away and the maggots, often 10 times bigger after eating the dead tissue, are then flushed away.
A number of medical studies have shown maggot therapy can achieve more effective results than surgical debridement. However, due to the nature of this type of treatment, many patients are reluctant to try it.
Infection
Serious infections are usually treated with antibiotics, which can be:
- oral antibiotics – antibiotic tablets or capsules
- intravenous – injected directly through your vein
- intramuscular – injected directly into your muscles
To counter the effects of infection, and accelerate the healing process, you will also require intravenous fluids and nutrients and, in some instances, blood transfusions.
Vascular surgery
There are two main ways that surgery can be used to restore blood flow. These are described below.
- Bypass surgery – where the surgeon redirects the flow of blood and bypasses the blockage by connecting (grafting) one of your veins to a healthy part of an artery.
- Angioplasty – where a tiny balloon is placed into a narrow, or blocked, artery and is inflated to open up the vessel. A small metal tube, known as a stent, may also be inserted into the artery to help keep it open.
Research suggests that both techniques are equally effective in restoring blood flow and preventing the need for amputation. Around four out of five people who receive either type of surgery will not need an amputation.
An angioplasty has the advantage of having a faster recovery time than bypass surgery, although it may not be as effective in the long term as bypass surgery.
Hyperbaric oxygen therapy
An alternative treatment for some forms of gangrene is hyperbaric oxygen therapy.
During this treatment you are placed in a specially designed chamber filled with pressurised air and that also contains a plastic hood filled with pure oxygen. This hood is placed over the damaged body part.
The treatment results in high levels of oxygen being dissolved in your bloodstream, leading to more oxygen being delivered to the affected areas, which speeds up healing. Hyperbaric oxygen therapy also stops damage caused by the bacteria as the oxygen 'switches off' production of toxins.
Hyperbaric oxygen therapy has proved effective in treating gangrene resulting from infected diabetic foot ulcers, reducing the risk of amputation.
Evidence relating to the effectiveness of hyperbaric oxygen therapy in treating other types of gangrene is limited, and further research is required.
Reconstructive surgery
Reconstructive surgery using a skin graft (skin taken from elsewhere on the body) may be used to cover the area of skin damaged by gangrene.
During a skin graft, the surgeon will remove healthy skin from another part of your body (usually a part that would be covered by clothing), and then reconnect (graft) it to the damaged area of skin.
