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Wet gangrene
Last reviewed: 12.07.2025
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Complication of soft tissue breakdown by bacterial infection results in colliquative or purulent necrosis, diagnostically defined as infectious or wet gangrene. [ 1 ]
Causes wet gangrene
Wet gangrene can have causes such as severe burns, soft tissue ulcers, frostbite or injuries. Most often, wet gangrene occurs in the lower extremities: fingers, feet, shins - as they are prone to swelling with deterioration of blood flow and capillary circulation. More information in the materials:
This complication often develops in people with diabetes who injure a toe or foot. Wet gangrene in diabetes is discussed in the article - Dry and wet gangrene of the toes in diabetes mellitus [ 2 ]
Unlike dry (ischemic) gangrene, wet gangrene always involves a pathogen causing a necrotic infection: β-hemolytic group A streptococcus (Streptococcus pyogenes), staphylococci (Staphylococcus aureus, Staphylococcus epidermidis), Proteus (Proteus mirabilis), Pseudomonas aeruginosa, anaerobic bacteria Clostridium spp., intestinal bacteria (Escherichia coli), enterobacteria (including Klebsiella aerosacus), bacteroides (Bacteroides fragilis). [ 3 ]
In addition, if a microbial infection begins to develop in dead tissue during dry gangrene, it can develop into a wet infection, especially in diabetics and HIV-infected people. [ 4 ]
Risk factors
The risk factors for the development of wet gangrene are:
- injuries, primarily deep burns, frostbite, prolonged mechanical (compression) impact, stab wounds, etc.;
- infection of open wounds;
- diabetes mellitus – with trophic ulcers on the legs and diabetic foot syndrome;
- atherosclerosis and chronic diseases of the peripheral vessels of the lower extremities, accompanied by soft tissue ischemia;
- long-term smoking, chronic alcoholism;
- intracavitary surgical interventions.
Pathogenesis
The mechanism of development, i.e. the pathogenesis of wet gangrene, is associated with the penetration of infection (invasion) into deeper tissues – into the intercellular space and inside the cells – and their swelling under the influence of toxins and enzymes produced by bacteria (hyaluronidase, neuraminidase, lecithinase, plasmacoagulase, etc.). [ 5 ], [ 6 ]
This leads to blocking of venous and lymphatic outflow and blood flow to tissues with cessation of their nutrition and the inability of blood leukocytes and phagocytes to resist the rapid proliferation of bacteria in the area of alteration. As a consequence, the development and exacerbation of infection with necrosis (death) and purulent melting of tissues occurs. [ 7 ]
Read more in the publication – Gangrene
Symptoms wet gangrene
The first signs - in the initial stage of wet gangrene - appear as localized swelling (edema) and redness, as well as general subfebrile fever (with chills) and severe aching pain.
As the pathological process progresses, which in this type of gangrene occurs very quickly, other symptoms appear: the area of dead tissue may become brown-red, purple-violet or greenish-black - with the formation of blisters and ulcers; fragments of non-viable skin and subcutaneous tissue peel off; a rather loose dirty-gray scab forms on the dead tissue; an exudate of a serous-purulent nature is released, which has a disgusting odor.
In this case, the boundary between the dead tissue of the gangrenous area and healthy tissue – the demarcation line in wet gangrene – is practically absent.
Forms
Experts distinguish the following types or subtypes of wet gangrene:
- Fournier's gangrene (necrotizing fasciitis or necrosis of the connective tissue of the male genitalia);
- internal gangrene (or acute gangrenous inflammation) of various tissues and organs - wet gangrene of the intestine, appendix, gallbladder, bile duct or pancreas;
- Meleni's synergistic gangrene or bacterial synergistic gangrene, which can develop in patients after surgery (in the second week after its implementation) and is caused by Staphylococcus aureus and streptococcal infection.
Also common in Africa and Asia is wet gangrene of the soft tissues of the face or noma, caused by Staphylococcus aureus, anaerobic bacteria Prevotella intermedia, Fusobacterium necrophorum, Tannerella forsythia, pathogenic bacteroids Porphyromonas gingivalis, etc. This wet gangrene is especially common in children aged two to six years who live in regions south of the Sahara – in conditions of extreme poverty, unsanitary conditions and constant malnutrition. Experts believe that this disease (with a 90% infant mortality rate) is a consequence of acute ulcerative necrotic inflammation of the gums. [ 8 ]
Complications and consequences
The development and progression of wet gangrene can be rapid and lead to life-threatening complications and consequences.
The toxic compounds produced by the bacteria are absorbed and enter the bloodstream, causing general intoxication of the body, multiple organ failure, sepsis and death.
Diagnostics wet gangrene
When diagnosing wet gangrene, a complete examination of the affected limb is carried out.
Tests include a complete blood count and biochemistry with differential and ESR, a coagulogram, serum creatinine and lactate dehydrogenase levels, wound culture (for bacterioscopic examination) or skin biopsy to determine microbial culture. [ 9 ]
Instrumental diagnostics uses X-rays and ultrasound of soft tissues, CT or MRI angiography.
Differential diagnosis
Differential diagnosis includes abscesses, necrotic erysipelas, infected dermatitis and gangrenous pyoderma. Dry and wet gangrene are usually differentiated clinically. [ 10 ]
Treatment wet gangrene
It is necessary to begin treatment of wet gangrene as early as possible due to its rapid development, which requires emergency medical care, including surgery.
In this case, surgical treatment consists of surgical debridement of non-viable tissues – necrectomy.
The main drugs are systemic (administered parenterally) broad-spectrum antibiotics, including drugs of the penicillin group, cephalosporins, lincosamides, macrolides and glycopeptide antibiotics. [ 11 ]
Additionally, for better tissue healing, physiotherapy treatment can be used – hyperbaric oxygenation.
Radical surgical intervention – amputation of a part of the limb – is performed when attempts to stop the pathological process with antibacterial drugs are unsuccessful. And internal gangrene requires extensive surgery to remove the gangrenous tissue. [ 12 ]
Prevention
To avoid the development of wet gangrene, antiseptic treatment of any wound is necessary. And doctors advise patients with diabetes to protect their feet from traumatic injuries and regularly inspect them, since even a scratch that is not noticed in time can become a gateway for infection with the development of a necrotic process in the tissues.
Forecast
Experts consider the prognosis of wet gangrene to be uncertain, since everything depends on its stage at the time of seeking medical help and adequate treatment. This also determines how long people live with wet gangrene. Without treatment, 80% of patients with gangrene die; after treatment, up to 20% of patients survive for five years. Moreover, according to clinical observations, after amputation of the affected limb below the knee in 15% of cases [ 13 ], amputation above the knee was required two years later, and a third of cases resulted in death.