From the Guidelines
Treatment for gangrene requires immediate medical attention and typically involves a combination of approaches, including surgical debridement, antibiotics, and revascularization procedures. The primary goal is to remove dead tissue, fight infection, and restore blood flow to affected areas. For wet gangrene, broad-spectrum antibiotics like piperacillin-tazobactam, meropenem, or combinations including metronidazole are administered intravenously, often for 1-2 weeks depending on severity, as recommended by the 2021 WSES-AAST guidelines 1.
Key Components of Treatment
- Surgical debridement to remove dead tissue, which should be performed as soon as possible, as recommended by the 2021 WSES-AAST guidelines 1
- Antibiotics to fight infection, with initial coverage including gram-positive, gram-negative, aerobic, and anaerobic organisms, and an anti-MRSA agent, as suggested by the 2021 WSES-AAST guidelines 1
- Revascularization procedures to restore blood flow to affected areas, which may include surgical or endovascular interventions
- Hyperbaric oxygen therapy as an adjunctive treatment to enhance tissue oxygenation and promote healing, as mentioned in the 2021 WSES-AAST guidelines 1
- Pain management and wound care are essential components of treatment
Surgical Approach
- Early and aggressive surgical debridement is recommended to improve survival and reduce the number of surgical revisions 1
- A multidisciplinary and tailored approach should be taken, considering the extent of perineal involvement, degree of fecal contamination, and possible presence of sphincter or urethral damage, as suggested by the 2021 WSES-AAST guidelines 1
Antibiotic Regimen
- Empiric antimicrobial therapy should be started as soon as the diagnosis is suspected, covering gram-positive, gram-negative, aerobic, and anaerobic bacteria, and including an anti-MRSA agent 1
- Microbiological samples should be obtained at the index operation to guide specific antibiotic management, as recommended by the 2021 WSES-AAST guidelines 1
Prevention
- Managing underlying conditions like diabetes and peripheral vascular disease
- Maintaining good foot hygiene
- Avoiding smoking
- Seeking prompt medical attention for wounds that show signs of infection or poor healing, as emphasized in the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline 1
From the Research
Treatment Options for Gangrene
The treatment for gangrene typically involves a combination of surgical, medical, and supportive therapies. Some of the key treatment options include:
- Surgical debridement to remove dead tissue and prevent the spread of infection 2, 3, 4, 5
- Antibiotic therapy to treat underlying infections 2, 3, 4, 5, 6
- Hyperbaric oxygen therapy to reduce systemic toxicity and promote healing 2, 3, 4, 5, 6
- Negative pressure wound therapy to manage wounds and promote tissue growth 4
- Supportive care, such as pain management and wound care, to promote overall recovery 2, 3, 4, 5
Importance of Early Treatment
Early recognition and treatment of gangrene are critical to reducing mortality and morbidity. Delayed treatment can lead to increased tissue damage, systemic toxicity, and poor outcomes 2, 3, 5, 6. A multifactorial approach to treatment, including surgical, medical, and supportive therapies, may significantly reduce the mortality and morbidity of this life-threatening disease 6.
Role of Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy has been shown to be an effective adjunctive treatment for gangrene, reducing systemic toxicity and promoting healing 2, 3, 4, 5. It is particularly useful in the treatment of clostridial gas gangrene, where it can help prevent further extension of the infection and improve overall outcomes 3, 5.