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Gangrene. Ischaemic gangrene of the toes in a heavy smoker. The black tissue is dead due to insufficient blood flow (ischaemia). Ischaemia in this case was probably caused by atherosclerosis, a condition that is most common in smokers and the elderly. Atherosclerosis causes constriction of blood vessels by deposits of atheroma - a mixture of fat, cholesterol and dead cells. The extremities of limbs are usually worst affected as such areas are furthest from the strong pumping action of the heart. Treatment for ischaemic gangrene includes vasodilator drugs to improve blood flow and antibiotics to prevent infection. Amputation is necessary if infection occurs.
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