Selulitis

Abses Kutan

Necrotizing Fasciitis

Gas Gangrene
 Bula
Nyeri hemoragik Nekrotik Gangren
tekan Bengkak besar

Defisit motorik
Eritema Nyeri Fluktuasi Krepitasi & sensorik
Indikator Nilai Skor

CRP >150 mg/L 4

Leukosit >25,000/mm3 2
Hb <11 g/dL 2

Natrium <135 mmol/L 2

Kreatinin serum >141 μmol/L 2

Gula darah >10 mmol/L 1

C. perfringens produksi 17 toxin
• Alpha  phospholipase  menghancurkan membran sel  sel mati  nekrosis; hemolitik, kardiotoksik
• Theta  menghancurkan vaskular & leukosit  respon inflamasi ↓
• Beta  nekrosis jaringan
• Delta  hemolysin 
• Epsilon  permease 
• Iota  nekrosis jaringan
• Kappa  kolagenase  menghancurkan jaringan ikat  menyebar cepat  otot; gelatinase, nekrosis jaringan
• Lambda  protease
• Mu  hyaluronidase
• Nu  deoxyribonuclease, hemolitik, dan nekrosis jaringan 
• Phi  hemolysin, cytolysin

Progres jam - minggu

Dalam hitungan jam  syok, sepsis, meninggal

TANDA DAN GEJALA

Demam

Nyeri
• Bila mengenai saraf  nyeri ↓

Discharge: dishwater appearance, bau busuk

Tanda sepsis
• Syok sepsis, ARDS, DIC, Hemolisis
 TATALAKSANA

Antibiotik empirik
• Jangan tunggu hasil kultur, mulai dengan broad-spectrum
• Vancomycin & tazobactam atau carbapenem/ceftriaxone & metronidazole
• Clindamycin & penicillin

Surgical emergency with debridement

• Seluruh jaringan nekrotik + irigasi normal saline
• Dilakukan berulang/setiap hari sampai jaringan nekrosis dan infeksi hilang
• Fasciotomi jika diperlukan

Resusitasi IV

Monitoring ICU

Terapi hiperbarik oksigen adjuvan

Terapi Hiperbarik Oksigen
 Post-operasi dan Rehabilitasi

• Perawatan luka
– Negative wound pressure therapy (NPWT)
• Penutupan luka
– Skin graft
– Flap
• Rehabilitasi
– Physical therapy
– Occupational therapy

Buboltz JB, Murphy-Lavoie HM. Gas Gangrene. InStatPearls [Internet] 2019 Jan 4. StatPearls Publishing.
Aggelidakis J, Lasithiotakis K, Topalidou A, Koutroumpas J, Kouvidis G, Katonis P. Limb salvage after gas gangrene: a case report and review of the literature. World Journal of Emergency Surgery.
2011;6(1):28.
 Daftar Pustaka
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fasciitis from other soft tissue infections. Critical care medicine. 2004 Jul 1;32(7):1535-41.
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• Buboltz JB, Murphy-Lavoie HM. Gas Gangrene. InStatPearls [Internet] 2019 Jan 4. StatPearls Publishing.
• Aggelidakis J, Lasithiotakis K, Topalidou A, Koutroumpas J, Kouvidis G, Katonis P. Limb salvage after gas gangrene: a case report and review of the
literature. World Journal of Emergency Surgery. 2011;6(1):28.