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