Gangrene gas

Surgical diseases

Gangrene gas - subfascial anaerobic infection, accompanied by necrosis of muscle tissue and pronounced intoxication of the body. The disease is caused by obligate anaerobes (Cl. Perfringens, Cl. Novyi, CI. Septicum, Cl. Histolyticum), which inhabit the earth and street dust. Wounds contaminated by the earth, having wound pockets, necrosis areas, poorly blood-supplying tissues not subjected to primary surgical treatment, are predisposed to gas gangrene. The causative agent quickly acquires virulence, releases the gas-forming and dissolving tissues of exo- and endotoxins, which contribute to the rapid spread of the infection.

Symptoms, course. Already 6 hours after the acquisition of a virulence microbe, there are violations of the general state with tachycardia and fever. Skin covers are gray-blue. The wound is sharply painful, its edges are pale, edematous, lifeless, the bottom of the wound is dry. The color of the muscles visible in the wound resembles boiled meat. When pressing on the edges of the wound from the tissues, bubbles of gas with an unpleasant sweet-putrefactive odor are emitted. Fingers determine typical crepitus. The patient's condition deteriorates rapidly, a shock comes. Radiographically determined "porosity" of muscle tissue. Differential diagnosis is performed with 31 and / | fascial gas-forming phlegmon (no muscle damage) and a purine infection.

Treatment. "Pump" cuts of skin, muscles, fascia with excision of necrotic and suspicious for necrosis sites. Drainage of the wound with washing with a solution of hydrogen peroxide and antibiotics, the wound remains open. Absolute rest of the limb. Penicillins up to 20 000 000 - 40 000 000 units / day (2-3 times a day in / in) for 10-14 days, tetracyclines. Anti-gangrenous serum and anatoxin are ineffective both in the treatment and in the prevention of gas gangrene. With a rapid increase in intoxication - the guillotine amputation of the limb. Effective hyperbaric oxygenation, however, it does not exclude surgical sanitation of the wound, the indications of which are clinical and radiological signs of gas gangrene with microscopically proven presence of clostridia in the wound.

The forecast is always very serious.

Prophylaxis consists in the timely qualified primary surgical treatment of all contaminated wounds.