Gas Gangrene
(also known as Clostridial myonecrosis)
Acute necrotic condition of the soft tissue that leads to death and deterioration of a part of the body, caused by interference with blood supply and infection.
The causative agent is the gas-forming anaerobic bacteria Clostridium perfringens which grows in tissues that have low oxygen tension caused by trauma or ischemia. Some conditions with low-oxygen tension are as follows:
- Minor injuries in the immunocompromised patients (HIV/AIDS, diabetes mellitus)
- Any kind of surgery (traumatic or surgical interruption of blood supply)
- Deep contamination of wound due to foreign body, soft tissue trauma and bone fracture
C. perfringens releases alpha-exotoxin that produces lethal gas, which is rapidly spreading to the muscle causing massive tissue swelling and necrosis.
Clinical symptoms of gas gangrene are :swollen painful wound with gas bubble in the drainage, crepitus is felt in the soft tissue, systemic toxemia and failure of organ systems in the body (renal damage and cardiotoxicity).
Hyperbaric oxygen therapy is a safe and effective adjunctive treatment since it works synergistically with antibiotics. Hyperbaric oxygen has bacteriostatic and bactericidal properties help kill and eliminate the bacteria. Saturation of the tissues with oxygen counteracts the life cyle of C. perfringens as it does not thrive well in an oxygen-rich environment. This decreases incidences of surgeries and amputations. Hyperbaric oxygen is a tissue-, limb- and life-saving treatment of myonecrosis.
- Reduces infection by inhibition of alpha-toxin (bacteriostatic effect-formation of oxygen free radicals that prevent further alpha-toxin production)
- Enhances the effect of some antibiotics by helping in better penetration
- Provides faster and clear demarcation between dead and healthy tissue
- Promotes wound healing by restoration in blood supply
- Reduces edema by vasoconstriction
- Improves osteoclastic activity (removing necrotic bone)
Further reading:
- Babior BM: Oxygen-dependent killing by phagocytes. New Eng J Med; 298:659-668, 1978
- Bakker DJ: The treatment of acute skin gangrene (necrotizing fasciitis and progressive bacterial gangrene) with hyperbaric oxygenation.Ned Tijdschr Geneeskd;124 (51):2164-70, Dec 1980
- Bayliss GJ, Cass C: Hyperbaric oxygen used in the treatment of gas gangrene. Med J Aust; 2 (22): 991-3, 25 Nov 1967
- Bogetti B, Viotti G, Zannini D, Marcenaro A: Practical aspects of the treatment of gas gangrene with hyperbaric oxygen. Minerva Med; 72(22): 1409-11, 31 May, 1981
- Demello FJ, Hashimoto T, Hitchcock CR, Haglin JJ: The effect of hyperbaric oxygen on the germination and toxin production of Clostridium perfringens spores. In Wada J. and Iwa J.T. (eds): Proceedings of the Fourth International Congress on Hyperbaric Medicine. Baltimore: The Williams & Wilkins Co, p. 276,1970
- Eraklis AJ, Filler RM, Pappas AM, Bernhard WF: Evaluation of hyperbaric oxygen as an adjunct in the treatment of anaerobic infections. Am J Surg; 117(4): 485-92, Apr 1969
- Gibson A, Davis FM: Hyperbaric oxygen therapy in the management of Clostridium perfringens infections. N Z Med J; 99 (808): 617-20, 27 Aug, 1986
- Gonzalez MH: Necrotizing fasciitis and gangrene of the upper extremity. Hand Clin; (4): 635-45, ix. Review, 14 Nov, 1998
- Guidi ML, Proietti R, Carducci P, Magalini SI, Pelosi G: The combined use of hyperbaric oxygen, antibiotics and surgery in the treatment of gas gangrene. Resuscitation; 9(4):267-73, Dec 1981
- Hart GB, Lamb RC, Strauss MB: Gas gangrene I. A cullective review. II. A 15-year experience with hyperbaric oxygen. J Trauma; 23:991-1000, 1983
- Hart GB, Strauss MB: Gas gangrene–clostridial myonecrosis: a review. Journal of Hyperbaric Medicine; 5(2): 125-144, 1990
- Hirn M: Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis. A clinical and experimental study. Eur J Surg Suppl; (570): 1-36, Review, 1993
- Jain KK: Textbook of hyperbaric medicine: Ch 13: Hyperbaric Oxygen Therapy in Infections, Hogrefe& Huber Publishers, Inc., 3rd Ed.13: 189 –211, 1999
- Jain KK: Textbook of hyperbaric medicine: Ch 14: Hyperbaric Oxygen Therapy in Wound Healing, Plastic Surgery, and Dermatulogy, Hogrefe & Huber Publishers, Inc., 3rd Ed.14: 213– 241, 1999
- Korhonen K, Klossner J, Hirn M, Niinikoski J: Management of Clostridial gas gangrene and the rule of hyperbaric oxygen.Ann Chir Gynaecul; 88(2):139-42, 1999
- Lindsey D: Hyperbaric oxygen and gas gangrene. Br J Hosp Med; 55 (3): 147, 7-20 Feb, 1996
- Morgan MS, Lytle J, Bryson PJ: The place of hyperbaric oxygen in the treatment of gas gangrene. Br J Hosp Med; 53 (9): 424-6, 3-16 May 1995
- Owada R, Kanamori A, Hirai N, Yajima Y: A case of NIDDM with non-clostridial gas-producing infection in the lower limb–the effects of hyperbaric oxygen therapy. Kansenshogaku Zasshi; 68(2): 263-7, Feb 1994
- Poulton TJ: Hyperbaric oxygen therapy for gas gangrene. N Engl J Med; 302 (16): 920, 17 Apr 1980
- Ramon Suler R, Baxarias Gascon P, Mas Marfany J: Gas gangrene: treatment with hyperbaric oxygen. Rev Esp Anestesiul Reanim; 27(6): 493-500, Nov 1980
- Stephens MB: Gas gangrene: potential for hyperbaric oxygen therapy. Postgrad Med; 99(4): 217-20, 224, Apr 1996
- Thom S: A rule for hyperbaric oxygen in Clostridial myonecrosis. Clin Infect Dis; 17(2): 238, Review, Aug 1993
- Tonjum S: Gas producing infections and hyperbaric oxygen therapy. Tidsskr Nor Laegeforen; 100(6): 387-8, Feb 29, 1980
- Unsworth IP, Sharp PA: Gas gangrene. An 11-year review of 73 cases managed with hyperbaric oxygen. Med J Aust; 140 (5): 256-60, Mar 3,1984
