Gas gangrene 8 - 2- 16

GAS GANGRENE

DR.R.DURAI MSASSISTANT PROFESSOR

DEPT. OF GENERAL SURGERYMGMCRI

2 What is a Gangrene?

localized cell death by obstructed circulation with superadded bacterial infection.

08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI

3 What is a Gas Gangrene?

Gangrene produced gas producing organisms like Clostridium perfringens(welchii)

Oedematous myonecrosis – Skeletal muscle Malignant edema


GAS GANGRENE BY DR.R.DURAI MGMCRI

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08-02-2016

5 Source of Infection

Contaminated, manured or cultivated soil, intestines Faecal flora Crush wounds War wounds Anaerobic environment


6 Organisms

Clostridium welchii (perfringens): Gram-positive, central spore bearing, nonmotile, capsulated organisms

Clostridium oedematiens. Clostridium septicum. Clostridium histolyticum.


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8 TOXINS

Alpha (most common) Beta Epsilon Iota Phi toxin—myocardial depressant Kappa toxin—destruction of connective tissue and

blood vessels Bursting factor and circulating factor


9 EXOTOXINS

Lecithinase Haemolysin Hyaluronidase Proteinase


10 EFFECTS

Anaerobic myositis/myonecrosis. – Hydrogen Sulphide gas –black/ brown muscle

Extensive spread – thoracic & abdominal wall Foaming Liver


11 Clinical Features Incubation period is 1-2 days Toxaemia Fever Tachycardia Pallor

GAS GANGRENE BY DR.R.DURAI MGMCRI 08-02-2016

12 Contd… Wound is under tension with foul smelling discharge (sickly

sweety/decaying apple odour). Khaki brown coloured skin Crepitus Jaundice ,oliguria Frequent sites are adductor region of the lower limb and

buttocks and subscapular region in upper limb.


13 Clinical Types

Fulminant type Massive type Group type Single muscle type Subcutaneous type


14 Investigations

X-ray LFT ,RFT, ABG CT Gram Stain Robertson’s Cooked meat media – meat to turn pink

with sour smell and acid reaction. Nagler reaction.


15 Complications

Septicaemia, toxaemia. Renal failure, liver failure. Circulatory failure, DIC, secondary infection. Death occurs in critically ill patients.


16 Treatment

Injection benzyl penicillin 20 lacs 4th hourly + Injection metronidazole 500 mg 8th hourly + Injection aminoglycosides (if blood urea is normal) or third generation cephalosporins or metronidazole.

Fresh blood transfusion Polyvalent antiserum 25,000 units given intrav

enously after a test dose and repeated after 6 hours Hyperbaric oxygen


17 Contd…

Radical Wound Debridement Rehydration Amputation Ventilator support Fumigation of theatre after treatment


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Healthcare

Gas gangrene 8 - 2- 16