Gas Gangrene Follow-up

  • Author: Hoi Ho, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Aug 16, 2011
 

Further Inpatient Care

  • Daily or repeated surgical debridement
  • Daily or repeated HBO therapy, if available
  • Intensive supportive care
  • Hemodialysis for renal failure, if indicated
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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.
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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.
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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.
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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
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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.
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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.
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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, Center for Advanced Teaching and Assessment in Clinical Simulation (ATACS), Paul L Foster School of Medicine, Texas Tech University Health Sciences Center; Consulting Physician, University Medical Center

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)

Juan B Figueroa-Casas, MD  Associate Professor, Division of Pulmonary and Critical Care Medicine, Texas Tech University Health Sciences Center at El Paso

Disclosure: Nothing to disclose.

David G Maxfield  Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

David G Maxfield, is a member of the following medical societies: American College of Physicians, Congress of Neurological Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Lorenzo B Aragon, MD  Associate Professor, Department of Family Medicine, Paul L Foster 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, American Medical Directors Association, Society of Teachers of Family Medicine, and Texas Medical Association

Disclosure: Nothing to disclose.

Enes Kanlic, MD  Professor, Department of Orthopedic Surgery, Texas Tech University Health Science Center

Disclosure: Stryker Honoraria Speaking and teaching

Specialty Editor Board

Pranatharthi Haran Chandrasekar, MBBS, MD  Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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: Baxter International and Johnson & Johnson Royalty Other

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.

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.

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A patient developed gas gangrene after injecting cocaine. Clostridium septicum was isolated in both blood and wound cultures.
Gas feathering in the arm soft tissue of a patient with gas gangrene.
Extension of gas gangrene to the chest wall despite initial debridement.
 
 
 
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