GAS GANGRENE

Dr. Ehsanur Reza Shovan

• It is a rapidly progressive, potentially fatal condition
characterized by widespread necrosis of the
muscles and subsequent soft-tissue destruction.

• This is a dreaded consequence of inadequately

treated missile wounds, crushing injuries and high-
voltage electrical injuries.
 Causative agent
• Clostribium species – spore forming, Gram +ve
• They are present in the
soil and have also been
isolated from the human
gastrointestinal tract and
female genital tract.

• Non-clostridial gas-
producing organisms such
as coliforms have also
been isolated in 60–85% of
cases of gas gangrene.
 vegetative
cells multiply
Spores Carbohydrates
germinate Fermentation

Anaerobic
PATHOGENESIS Gas production
In tissues
environment Incubation period is
1-7 days

Distension of
Toxemia and tissues
death Interfering
Blood supply
Ischemia/
gangrene
Pathogenesis
 Epidemiology

– The persons at risk those with Diabetes Mellitus,

blood vessel disease and colon cancer

– Contact with contaminated cloth and other

foreign material

– Trauma or recent surgical wound

 Symptoms
• High fever
• Shock
• Massive tissue destruction
• Blackening of skin
• Severe pain around a skin of wound
• Blisters with gas bubbles form near the
infected area,
• the heartbeat and breathing become
rapid.
 Presentation
Crepitation in tissues,
sickly sweet odor discharge,
rapidly progressing necrosis,
fever, hemolysis, toxemia,
shock,
renal failure, and death
Lab. Investigations

Culture and sensitivity

Storming fermentation
Lecithinase test
G
A
S

I
N

S
O
F
T

T
I
S
S
U
E
G
A
S

I
N

U
T
E
R
U
S
G
A
S

I
N

U
T
E
R
U
S
G
A
S

I
N

U
T
E
R
U
S
 Prevention
• Cleaning the wound
• Avoid the contaminated material
• improve circulation in
patients with poor circulation
• antitoxin
 Prevention
(1) Do a thorough wound toilet.
(2) In high risk wounds give the patient
penicillin 1.5 megaunits 4 hourly,
or tetracycline
 Treatment

• High doses of antibiotic : Penicillin

• The dead tissue is removed or limbs are

amputated

• No vaccine
10 megaunits of benzyl penicillin daily for 5
days as four 6 hourly doses.

Or
Tetracycline 0.5 g intravenously
or 1 g orally every 6 hours.

Clostridia not sensitive to metronidazole,

some other anaerobic bacteria are, so give
it.
 EXPLORATION

Do this in a septic theatre,

or even in the out-patient department,
and not where clean cases go for operation.
 AMPUTATION
Amputate under a tourniquet
Close the stump by delayed
primary suture
Myonecrosis of right leg
Myonecrosis of left foot
Stump of above knee amputation
• Patients should be admitted to ICU and
treated aggressively with careful monitoring.
• The role of HBO is not as clear as in
necrotising fasciitis but it is recommended in
severe cases if the facilities are available.
– increases the normal oxygen saturation in the
infected wounds by 1000-fold leading to
• Bacteriocidal effect,
• Improves neutrophil function,
• Enhanced wound healing