Gas Gangrene Follow-up
- Author: Hoi Ho, MD; Chief Editor: Burke A Cunha, MD more...
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.
Further Inpatient Care
See the list below:
- Daily or repeated surgical debridement
- Daily or repeated HBO therapy, if available
- Intensive supportive care
- Hemodialysis for renal failure, if indicated
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.
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.
See the list below:
- 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
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.
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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