This rare condition is caused by local infection with the anaerobic, spore-forming, gram-positive, rod-shaped bacillus Clostridium perfringens or another clostridial species. It occurs in devitalized tissues and results from compromised arterial circulation after trauma or surgery. The usual incubation period is 1 to 4 days but can vary from 3 hours to 6 weeks or longer.
Gas gangrene carries a high mortality unless therapy begins immediately. With prompt treatment, 80% of patients with gas gangrene of the extremities survive; the prognosis is poorer for gas gangrene in other sites, such as the abdominal wall or the bowel.
Causes of gangrene include:
Symptoms and Signs
Symptoms of gangrene may include:
Several tests confirm the diagnosis. Anaerobic cultures of wound drainage show C. perfringens; a Gram stain of wound drainage discloses large, grampositive, rod-shaped bacteria; X-rays reveal gas in tissues; and blood studies show leukocytosis and, later, hemolysis.
Diagnostic tests must rule out synergistic gangrene and necrotizing fasciitis. Unlike gas gangrene, both of these disorders anesthetize the skin around the wound.
Appropriate treatment includes careful observation for signs of myositis and cellulitis. The patient needs immediate treatment if these signs appear and immediate wide surgical excision of all affected tissues and necrotic muscle in myositis. Delayed or inadequate surgical excision is fatal.
The patient also needs I.V. administration of antibiotics and, after adequate debridement, hyperbaric oxygenation, if available. For 1 to 3 hours every 6 to 8 hours, the patient is placed in a hyperbaric chamber and exposed to pressures designed to increase oxygen tension and prevent multiplication of the anaerobic Clostridia. Surgery may take place within the hyperbaric; chamber if the chamber is large enough.
Cultural Tip If the patient requires amputation of the affected part, ask family members about their wishes for disposal. Members of some cultures may wish to bury the part with a formal ceremony.
Clean any skin injury thoroughly. Watch for signs of infection (such as redness, pain, drainage, or swelling around a wound), and consult your health care provider promptly if these occur.
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