Gangrene

Basics

Description

  • Gas gangrene or clostridial myonecrosis
  • An acute, rapidly progressive, potentially fatal, gas-forming necrotizing infection of healthy muscle and soft tissue
  • Develops contiguously from a nearby area of trauma/surgery or hematogenously
  • Can be seen in posttraumatic or postoperative situations
  • Rapidly progressive invasion and destruction of healthy muscle tissue

Etiology

  • Clostridial organisms:
    • Facultative anaerobic, spore-forming, gram-positive bacillus
    • Produces a number of toxins; the most prevalent and lethal is α-toxin which is largely responsible for tissue destruction
  • Clostridium perfringens is the most common bacterium in traumatic gas gangrene; found in 80–90% of wounds
  • Clostridium septicum is most commonly associated with spontaneous or hematogenous gas gangrene
  • Other clostridial bacteria include C. novyi, C. histolyticum, C. bifermentans, C. fallax, and C. sordellii
  • 2 distinct mechanisms for introduction of clostridial organisms:
    • Traumatic and postoperative:
      • Spores introduced in deep tissue, proliferate in anaerobic environment
    • Nontraumatic associated with:
      • Immunocompromised states
      • Diabetes mellitus
      • Peripheral vascular disease
      • Alcoholism
      • IV drug abuse
      • Malignancies

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