PRESENTED BY

OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING
 GAS
GANGRENE

Dr. Ehsanur Reza Shovan

 INTRODUCTION
Gangrene is the death of body tissue. Clostridial
myonecrosis, a type of gas gangrene, is a fast-
spreading and potentially life-threatening form
of gangrene caused by abacterial infection
from Clostridium bacteria. The infection causes
toxins to form in the tissues, cells, and blood
vessels of the body. These bacteria will release
toxins that cause tissue death and release a gas.
 Definition

Rapidly spreading gangrene affecting

injured tissue infected by a soil
bacterium and accompanied by the
evolution of foul-smelling gas.
• 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.
 Causes Gas Gangrene
Gas gangrene is most commonly caused by the Clostridium
perfringens bacterium. In some cases, it may be caused by
group A Streptococcus bacteria. The infection occurs
suddenly and spreads quickly.

Gas gangrene generally develops at a recent surgical or

injury site. In rare cases, it may happen spontaneously,
without an apparent cause.

Certain injuries have a higher risk of causing gas gangrene,

including:
muscle injuries
severely damaged tissues
wounds that are very deep
CON….
wounds that are contaminated with stool or dirt,
especially those that might occur on a farm
You are also at an increased risk for developing
this condition if you have:
diabetes
arterial disease
colon cancer
frostbite
open fractures
used a contaminated needle to inject substances
into your muscles
 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.
 SYMPTOMS OF GAS GANGRENE OFTEN
INCLUDE:
fever
air under the skin
pain in the area around a wound
swelling in the area around a wound
pale skin that quickly turns gray, dark red, purple, or black
blisters with foul-smelling discharge
excessive sweating
increased heart rate
Vomiting

yellow skin and eyes (jaundice) is a late sign

This condition spreads so rapidly that you can see obvious
changes in the skin of the affected area in just a few minutes.
 Presentation

Crepitation in tissues,
sickly sweet odor discharge,
rapidly progressing necrosis,
fever, hemolysis, toxemia,
shock,
renal failure, and death
 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
PathoPHYSIOLOGY
Lab. Investigations

Culture and sensitivity

Storming fermentation
Lecithinase test
 GAS GANGRENE DIAGNOSED

Diagnose gas gangrene by performing a physical

examination and ordering various tests.
Diagnostic testing may include:

SKIN CULTURE TO TEST

for the presence of Clostridium perfringens and
other bacteria blood tests to check for an
abnormally high white blood cell count, which
can indicate an infection
 IMAGING TESTS, SUCH AS AN ROUTINE X-RAY,

To visualize tissues and check for the presence

of gas or special studies such as magnetic
resonance imaging (MRI) or arteriogram
surgery to evaluate the spread of gas gangrene
within the body
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 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
COMPLICATIONS INCLUDE:
permanent tissue damage
jaundice
liver damage
kidney failure
shock
widespread infection
coma
death