Gangrene

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Basics

Description

  • Gas gangrene or clostridial myonecrosis
  • An acute, rapidly progressive, gas-forming necrotizing infection of healthy muscle and subcutaneous tissue
  • Develops contiguously from a nearby area or hematogenously
  • Can be seen in posttraumatic or postoperative situations
  • 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
  • Clostridium perfringens is the most common bacterium; found in 80–90% of wounds
  • α-toxin is largely responsible for tissue destruction
  • Other clostridial bacteria include C. novyi, C. septicum, C. histolyticum, C. bifermentans, and C. fallax
  • 2 distinct mechanisms for introduction of clostridial organisms:
    • Traumatic and postoperative
    • Spores introduced in deep tissue, proliferate in anaerobic environment
    • Nontraumatic associated with diabetes mellitus, peripheral vascular disease, alcoholism, IV drug abuse, and malignancies

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Basics

Description

  • Gas gangrene or clostridial myonecrosis
  • An acute, rapidly progressive, gas-forming necrotizing infection of healthy muscle and subcutaneous tissue
  • Develops contiguously from a nearby area or hematogenously
  • Can be seen in posttraumatic or postoperative situations
  • 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
  • Clostridium perfringens is the most common bacterium; found in 80–90% of wounds
  • α-toxin is largely responsible for tissue destruction
  • Other clostridial bacteria include C. novyi, C. septicum, C. histolyticum, C. bifermentans, and C. fallax
  • 2 distinct mechanisms for introduction of clostridial organisms:
    • Traumatic and postoperative
    • Spores introduced in deep tissue, proliferate in anaerobic environment
    • Nontraumatic associated with diabetes mellitus, peripheral vascular disease, alcoholism, IV drug abuse, and malignancies

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