Gangrene: How Modern Vascular Surgery Can Save Your Limb

Introduction

“Blackened toe,” foul smell, or a wound that simply won’t heal can be frightening—but gangrene is often salvageable if treated early. At my centers in Thane (Ghodbunder Road, KIMS Hospital) and Mumbai (Ghatkopar, Mulund), we use modern endovascular techniques and advanced wound care to control infection, restore blood flow, and save limbs.

What is Gangrene?

Gangrene is tissue death due to poor blood supply and/or infection.

Types:

• Dry gangrene: from critical ischemia (very poor blood flow), often in toes/feet.
• Wet gangrene: ischemia plus infection; progresses quickly and needs urgent care.
• Gas gangrene: aggressive, toxin-producing infection—medical emergency.

Who is at Risk?

• Diabetes, Peripheral Arterial Disease (PAD)
• Smoking, high cholesterol, uncontrolled hypertension
• Chronic kidney disease, dialysis patients
• Foot trauma, ill-fitting footwear, previous ulcers or surgeries

Early Warning Signs You Shouldn’t Ignore

• Persistent pain or numbness; leg pain on walking or at rest
• Color change: pale → blue → black; coldness of toes/foot
• Foul smell, pus, or rapidly worsening wound
• Fever or feeling unwell (suggests infection spreading)

Act within hours—not days—if infection is suspected. Early action is the difference between a minor procedure and an amputation.

How We Diagnose the Cause (Quickly)

• Bedside vascular exam and wound assessment
• Doppler/ABI and Duplex ultrasound to map blood flow
• CT/MR Angiography when needed for detailed planning
• Blood tests and cultures (without delaying limb-saving treatment)
• TcPO₂/PVR for healing potential and surveillance (when appropriate)

Modern Limb-Salvage: Infection-First Protocol

Control Infection Immediately (first few hours)

• Start IV antibiotics promptly (then tailor to cultures).
• Sepsis bundle when indicated: fluids, labs, glycemic control, analgesia.
• Early involvement of ID/critical care if systemic illness.

Urgent Source Control (Debridement/Drainage)

• Remove necrotic tissue, drain pus, and decompress compartments if needed.
• Staged debridements are planned; wounds are left open initially.
• Consider limited amputation only when necessary to stop spread.

Restore Blood Flow (Revascularization After Stabilization)