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GAS GANGRENE
DR.R.DURAI MSASSISTANT PROFESSOR
DEPT. OF GENERAL SURGERYMGMCRI
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2 What is a Gangrene?
localized cell death by obstructed circulation with superadded bacterial infection.
08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
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3 What is a Gas Gangrene?
Gangrene produced gas producing organisms like Clostridium perfringens(welchii)
Oedematous myonecrosis – Skeletal muscle Malignant edema
08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
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GAS GANGRENE BY DR.R.DURAI MGMCRI
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5 Source of Infection
Contaminated, manured or cultivated soil, intestines Faecal flora Crush wounds War wounds Anaerobic environment
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6 Organisms
Clostridium welchii (perfringens): Gram-positive, central spore bearing, nonmotile, capsulated organisms
Clostridium oedematiens. Clostridium septicum. Clostridium histolyticum.
08-02-2016GAS GANGRENE BY DR.R.DURAI MGMCRI
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8 TOXINS
Alpha (most common) Beta Epsilon Iota Phi toxin—myocardial depressant Kappa toxin—destruction of connective tissue and
blood vessels Bursting factor and circulating factor
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9 EXOTOXINS
Lecithinase Haemolysin Hyaluronidase Proteinase
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10 EFFECTS
Anaerobic myositis/myonecrosis. – Hydrogen Sulphide gas –black/ brown muscle
Extensive spread – thoracic & abdominal wall Foaming Liver
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11 Clinical Features Incubation period is 1-2 days Toxaemia Fever Tachycardia Pallor
GAS GANGRENE BY DR.R.DURAI MGMCRI 08-02-2016
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12 Contd… Wound is under tension with foul smelling discharge (sickly
sweety/decaying apple odour). Khaki brown coloured skin Crepitus Jaundice ,oliguria Frequent sites are adductor region of the lower limb and
buttocks and subscapular region in upper limb.
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13 Clinical Types
Fulminant type Massive type Group type Single muscle type Subcutaneous type
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14 Investigations
X-ray LFT ,RFT, ABG CT Gram Stain Robertson’s Cooked meat media – meat to turn pink
with sour smell and acid reaction. Nagler reaction.
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15 Complications
Septicaemia, toxaemia. Renal failure, liver failure. Circulatory failure, DIC, secondary infection. Death occurs in critically ill patients.
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16 Treatment
Injection benzyl penicillin 20 lacs 4th hourly + Injection metronidazole 500 mg 8th hourly + Injection aminoglycosides (if blood urea is normal) or third generation cephalosporins or metronidazole.
Fresh blood transfusion Polyvalent antiserum 25,000 units given intrav
enously after a test dose and repeated after 6 hours Hyperbaric oxygen
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17 Contd…
Radical Wound Debridement Rehydration Amputation Ventilator support Fumigation of theatre after treatment
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