Gas gangrene is caused by gas-producing bacteria such as Clostridium perfringens infecting crushed or puncture wounds in an anaerobic environment. It leads to localized muscle death and tissue necrosis. Symptoms include pain, fever, and swelling at the wound site with a foul odor. The infection can spread rapidly without prompt treatment which includes intravenous antibiotics, debridement of dead tissue, and possibly amputation of an affected limb. Untreated gas gangrene has high mortality rates due to sepsis and organ failure.

1. GAS GANGRENE
DR.R.DURAI MS
ASSISTANT PROFESSOR
DEPT. OF GENERAL SURGERY
MGMCRI

2. What is a Gangrene?
 localized cell death by obstructed circulation with
superadded bacterial infection.
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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
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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.
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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
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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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