eMedicine Specialties > Infectious Diseases > Skin and Soft-Tissue Infections

Gas Gangrene: Follow-up

Author: Hoi Ho, MD, Associate Dean for Faculty Affairs and Development, Professor, Department of Internal Medicine, Director, Clinical Skills and Clinical Simulation Center, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Consulting Staff, Thomason Hospital
Coauthor(s): Lorenzo B Aragon, MD, Assistant Professor, Department of Family Medicine, Texas Tech University Health Sciences Center; Medical Director, Ambrosio Guillen Texas State Veterans Home; Jason W Tcheng, MS, Texas Tech University School of Medicine; Enes Kanlic, MD, Professor, Department of Orthopedic Surgery, Texas Tech University Health Science Center
Contributor Information and Disclosures

Updated: Jan 28, 2009

Follow-up

Further Inpatient Care

  • Daily or repeated surgical debridement
  • Daily or repeated HBO therapy, if available
  • Intensive supportive care
  • Hemodialysis for renal failure, if indicated

Further Outpatient Care

  • Gas gangrene is one of the most devastating infections. Patients who survive the infection often sustain extremity amputation or massive loss of muscles, skin, and soft tissues, requiring extensive reconstructive surgery and physical rehabilitation.
  • Patients with spontaneous gas gangrene may have occult malignancies of the GI tract. Carefully instruct these patients and monitor their cases appropriately.

Transfer

  • Aggressive surgical debridement and intensive medical therapy are the mainstays of treatment in gas gangrene; however, HBO therapy has become an important adjunctive therapy, especially in patients with truncal involvement.
  • Patients transferred for HBO therapy must be in stable condition. If compartment syndrome develops, do not delay fasciotomy to perform HBO therapy.

Deterrence/Prevention

  • Avoid suturing wounds due to a crush injury or open fractures with devitalized muscle and soil contamination.
  • Provide warnings and instructions of wound care to rescuers and health care workers about clostridial infections, including tetanus and gas gangrene, in injured victims of natural disasters such as earthquake or tsunami.

Complications

  • Massive hemolysis, which may require repeated blood transfusion
  • Disseminated intravascular coagulation (DIC), which may cause severe bleeding and may complicate aggressive surgical debridement
  • Acute renal failure
  • Acute respiratory distress syndrome
  • Shock

Prognosis

  • Failure to provide an early diagnose and inadequate surgical intervention are the two most common mistakes in the management of gas gangrene. These factors eventually dictate the outcome.
  • The prognosis of gas gangrene is better if the incubation period is shorter than 30 hours, if the patient has limb involvement, and if he or she does not have concomitant serious medical conditions or complications (eg, shock, DIC, ARDS, renal failure).
  • Spontaneous gas gangrene frequently carries a much worse prognosis than other forms of gas gangrene.

Patient Education

  • Educate patients with spontaneous gas gangrene about the strong association with occult malignancies, especially malignancies of the GI tract.
  • Educate intravenous drug users about potential fatal complications of gas gangrene due to injection of contaminated heroin or other chemicals.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider or to make an early diagnosis of gas gangrene
  • Conservative or inadequate surgical debridement
  • Failure to discuss the positive and negative aspects of HBO therapy with patients or their families, especially when HBO therapy is available at other local institutions
  • Failure to educate patients about the association of occult malignancy and spontaneous gas gangrene
  • Failure to refer patients for an appropriate workup to detect occult malignancy (eg, hematologic, GI)

Special Concerns

Patients with colonic adenocarcinomas and C septicum gas gangrene may have multiple metastatic infections, including the devastating mycotic aortic aneurysms.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthors Jeffrey P Nelson, MD; Miguel Angel Pena-Ruiz, MD; and Karl C Bentley, MS, to the development and writing of this article.



More on Gas Gangrene

Overview: Gas Gangrene
Differential Diagnoses & Workup: Gas Gangrene
Treatment & Medication: Gas Gangrene
Follow-up: Gas Gangrene
Multimedia: Gas Gangrene
References
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Further Reading

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Keywords

gas gangrene, clostridial myonecrosis, Clostridium perfringens, C perfringens, clostridial gas gangrene, Clostridium gas gangrene, Clostridium myonecrosis, clostridial species, clostridia, alpha-toxin, a-toxin, toxin-producing bacteria, gangrenous wound, Clostridium bifermentans, Clostridium septicum, Clostridium sporogenes, Clostridium novyi, Clostridium fallax, Clostridium histolyticum, Clostridium tertium, C bifermentans, C septicum, C sporogenes, C novyi, C fallax, C histolyticum, C tertium, spontaneous gas gangrene, posttraumatic gas gangrene, postoperative gas gangrene, uterine gas gangrene

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Contributor Information and Disclosures

Author

Hoi Ho, MD, Associate Dean for Faculty Affairs and Development, Professor, Department of Internal Medicine, Director, Clinical Skills and Clinical Simulation Center, Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Consulting Staff, Thomason Hospital
Hoi Ho, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Forensic Examiners, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Lorenzo B Aragon, MD, Assistant Professor, Department of Family Medicine, Texas Tech University Health Sciences Center; Medical Director, Ambrosio Guillen Texas State Veterans Home
Lorenzo B Aragon, MD is a member of the following medical societies: American Academy of Family Physicians and American Medical Directors Association
Disclosure: Nothing to disclose.

Jason W Tcheng, MS, Texas Tech University School of Medicine
Disclosure: Nothing to disclose.

Enes Kanlic, MD, Professor, Department of Orthopedic Surgery, Texas Tech University Health Science Center
Disclosure: Stryker Honoraria Speaking and teaching

Medical Editor

Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Pranatharthi Haran Chandrasekar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Charles V Sanders, MD, Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center
Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

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