Gas gangrene:
Oedematous myonecrosis of Skeletal muscle
Caused by Clostridium welchii (perfringens): Gram-positive, central spore bearing (mainly) or cl. Septicum, oedematiens or histolyticum. Produce exotoxins. Commonly enter the body through wounds contaminated with soil.
Toxaemia: Fever, Tachycardia , Pallor, Jaundice & oliguria It is characterized by progressive rapidly spreading edema. Wound is under tension with foul smelling discharge (sickly sweety/decaying apple odour). Khaki brown coloured skin, Crepitus in subcutaneous tissues.
Common sites: are adductor region of the lower limb and buttocks and subscapular region in upper limb.
Investigations:
- X-ray: ( appearance of gas under skin and in muscles.)
- LFT ,RFT, ABG,
- CT & Gram Stain
Complications:
- Septicaemia,
- DIC,
- Renal, liver & Circulatory failure and
- death in critically ill pt.
Treatment:
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Wound debridement, drainage and exposure.
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Antibiotics: penicillins, clindamycin & metronidazole
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Antibiotics are not effective without aggressive debridement.
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Putting the patient in a hyperbaric oxygen chamber may help (anerobic infection).
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Amputation may be required.
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*Fumigation of theatre after treatment *
