Gas gangrene

Gas gangrene

Despite the fact that antibiotics are readily available today, and in the operating rooms, newer means are used to ensure asepsis, it is not yet possible to get rid of gangrene.

Gas gangrene is a pathological process caused by an anaerobic spore-forming clostridial infection, accompanied by progressive edema and necrosis of soft tissues, gas formation and severe intoxication of the body with bacterial toxins and tissue decomposition products. The disease is caused by obligate anaerobes (Clostridium perfringens, Cl. Oedematiens, Cl. Septicum, Cl. Histolyticum), which inhabit land and street dust. Wounds contaminated with earth, having wound pockets, areas of necrosis, poorly blood-supplying tissues that have not been subjected to primary surgical treatment, are prone to gas gangrene. The pathogen quickly acquires virulence, secretes exo- and endotoxins, which produce gas and dissolve tissue, which contribute to the rapid spread of infection.

Symptoms and course

The incubation period can last from several hours to 7 days. In typical cases, already after the acquisition of virulence by the microbe, violations of the general condition with tachycardia and fever occur. The skin is gray-blue. The wound is sharply painful, its edges are pale, swollen, 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 it is possible to feel an unpleasant sweet-putrid odor from the tissue-gas bubbles. Fingers determine the typical crepitus.

The patient’s condition is rapidly deteriorating, shock occurs. Edema of the tissues during anaerobic infection does not leave a trace after pressing with a finger, clearly pronounced depressions at the hair root indicate tissue swelling. Gas formation, as a rule, begins with deep tissues and it is difficult to determine its presence by clinical methods in the initial period of the disease. In these cases, an x-ray method can be applied to determine the presence of gas in the deep layers of the tissue. Radiographically “porosity” of muscle tissue is determined. The following forms of anaerobic gangrene are distinguished: emphysematous, edematous (toxic), mixed, necrotic, phlegmonous, and tissue-melting. Each of these forms has some features of the flow. According to the clinical course, there are lightning and acute forms. The differential diagnosis is carried out with epi-fascial gas-forming phlegmon (no muscle damage) and putrid (putrid) infection.

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