Editing Gas gangrene


Devastating clostridial infection 

* Traumatic
** Gunshots
** Stabs
** Crush injuries and fractures, especially contaminated by soil
** Natural disasters
** Industrial
* Spontaneous
** DM
** Occult malignancy
** Immunosuppression including HIV
** PVD
** IVDU
** Malnutrition
* Procedural
** Gynaecological surgery/postpartum
** Radiation
** GIT surgery

Microbiology

* mostly Clostridium perfringens
* Clostridium septicum - patients should be evaluated for occult malignancy - 75% have cancer, either haematological or GIT

Clinically

* Pain out of proportion
* Tissue changes
* Hypotension, AKI, thrombocytopaenia
* Very high WCC

Surgical

* Amputation vs limb salvage
* Limb salvage:
** Vertical skin incision over area of maximal skin abnormality
** Inspect deeper muscle compartments - nonviable muscle is friable and peels away easily, with characteristic dark, maroon or pale appearance, and will not contract with cautery or bleed when cut
* Amputation
** Indicated with involvement of multiple muscle groups, or haemodynamic compromise

[[Category:Skin, soft tissue and wounds]]