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MYONECROSIS
OR GAS GANGRENE
Dr. Mansoor Khan
Resident Surgery, MBBS, FCPS-I
Khyber Teaching Hospital, Peshawar
BACTERIA
GRAM (+) GRAM (-)
AEROBIC ANAEROBIC AEROBIC ANAEROBIC
CLOSTRIDIUM
CLOSTRIDIUM PERFRINGENS
Clostridium perfringens A is important in
human
Cellulitis:
Infection with gas formation
in the soft tissue.
Fasciitis or suppurative myositis:
Infection and gas in the m...
Spores
germinate
Distension of
tissues
Interfering
Blood supply
Ischemia/
gangrene
Toxemia and
death
vegetative
cells mult...
Crepitation in tissues,
foul smelling discharge,
rapidly progressing necrosis,
fever, hemolysis, toxemia, shock,
renal fai...
Culture and sensitivity
Storming fermentation
Lecithinase test
Lab. Investigations
G
A
S
I
N
S
O
F
T
T
I
S
S
U
E
G
A
S
I
N
U
T
E
R
U
S
G
A
S
I
N
U
T
E
R
U
S
G
A
S
I
N
U
T
E
R
U
S
(1) Do a thorough wound toilet.
(2) In high risk wounds give the patient
penicillin 1.5 megaunits 4 hourly,
or tetracyclin...
Isolate the patient from other surgical patients
10 megaunits of benzyl
penicillin daily for 5 days as
four 6 hourly doses.
Or
Tetracycline 0.5 g
intravenously
or 1 g oral...
Do this in a septic theatre,
or even in the out-patient department,
and not where clean cases go for operation.
EXPLORATION
AMPUTATION
Amputate under a tourniquet
Close the stump by delayed
primary suture
Fournier,s gangrene
Myonecrosis of right leg
Myonecrosis of left foot
Stump of above knee amputation
Dr. Mohammad Zarin
FCPS, MRCS (Eng), FMAS
Assistant Prof. SCW
A disease caused by Clostridium tetani
characterized by local or generalized
spasmodic contraction of muscles
Gram positive, anaerobic,
spore forming rods
Clostridium tetani
Contamination of devitalized tissue
with the spores, germination of the spores,
release of tetanospasmin, the toxin reache...
TETANOSPASMIN
Inhibits release of an inhibitory
mediator
(e.g., GABA or glycine) which acts on
postsynaptic spinal neurons...
Localized tetanus
Confined to the musculature of
primary site of infection
Neonatal tetanus
(infection of the umbilical wo...
Generalized tetanus first the area of
injury, then the muscles of the jaw
(trismus or lockjaw risus sardonicus.
Other volu...
Prevention is much more
important than treatment:
1. Active immunization
with toxoid.
‘Booster shot’ for
previously immuni...
Prophylaxis
THANKS
Gas Gangrene Tetnus
Gas Gangrene Tetnus
Gas Gangrene Tetnus
Gas Gangrene Tetnus
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Gas Gangrene Tetnus

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Gas Gangrene Tetnus

  1. 1. MYONECROSIS OR GAS GANGRENE Dr. Mansoor Khan Resident Surgery, MBBS, FCPS-I Khyber Teaching Hospital, Peshawar
  2. 2. BACTERIA GRAM (+) GRAM (-) AEROBIC ANAEROBIC AEROBIC ANAEROBIC CLOSTRIDIUM
  3. 3. CLOSTRIDIUM PERFRINGENS Clostridium perfringens A is important in human
  4. 4. Cellulitis: Infection with gas formation in the soft tissue. Fasciitis or suppurative myositis: Infection and gas in the muscle planes. Myonecrosis: or gas gangrene: a life-threatening disease. Range of infections
  5. 5. Spores germinate Distension of tissues Interfering Blood supply Ischemia/ gangrene Toxemia and death vegetative cells multiply Spores germinate Carbohydrates Fermentation Gas production In tissues PATHOGENESIS Incubation period is 1-7 days
  6. 6. Crepitation in tissues, foul smelling discharge, rapidly progressing necrosis, fever, hemolysis, toxemia, shock, renal failure, and death Presentation
  7. 7. Culture and sensitivity Storming fermentation Lecithinase test Lab. Investigations
  8. 8. G A S I N S O F T T I S S U E
  9. 9. G A S I N U T E R U S
  10. 10. G A S I N U T E R U S
  11. 11. G A S I N U T E R U S
  12. 12. (1) Do a thorough wound toilet. (2) In high risk wounds give the patient penicillin 1.5 megaunits 4 hourly, or tetracycline Prevention
  13. 13. Isolate the patient from other surgical patients
  14. 14. 10 megaunits of benzyl penicillin daily for 5 days as four 6 hourly doses. Or Tetracycline 0.5 g intravenously or 1 g orally every 6 hours. Clostridia not sensitive to metronidazole, some other anaerobic bacteria are, so give it.
  15. 15. Do this in a septic theatre, or even in the out-patient department, and not where clean cases go for operation. EXPLORATION
  16. 16. AMPUTATION Amputate under a tourniquet Close the stump by delayed primary suture
  17. 17. Fournier,s gangrene
  18. 18. Myonecrosis of right leg
  19. 19. Myonecrosis of left foot
  20. 20. Stump of above knee amputation
  21. 21. Dr. Mohammad Zarin FCPS, MRCS (Eng), FMAS Assistant Prof. SCW
  22. 22. A disease caused by Clostridium tetani characterized by local or generalized spasmodic contraction of muscles
  23. 23. Gram positive, anaerobic, spore forming rods Clostridium tetani
  24. 24. Contamination of devitalized tissue with the spores, germination of the spores, release of tetanospasmin, the toxin reaches CNS by retrograde axonal transport or via the bloodstream the toxin is fixed to gangliosides in spinal cord or brainstem and exerts its actions
  25. 25. TETANOSPASMIN Inhibits release of an inhibitory mediator (e.g., GABA or glycine) which acts on postsynaptic spinal neurons (causing spastic paralysis).
  26. 26. Localized tetanus Confined to the musculature of primary site of infection Neonatal tetanus (infection of the umbilical wound): mortality > 90%, and developmental defects are present in survivors.
  27. 27. Generalized tetanus first the area of injury, then the muscles of the jaw (trismus or lockjaw risus sardonicus. Other voluntary muscles become involved gradually, resulting in generalized tonic spasms (opistotonus). Death usually results from interference with respiration. The mortality rate of generalized tetanus: ~50%.
  28. 28. Prevention is much more important than treatment: 1. Active immunization with toxoid. ‘Booster shot’ for previously immunized individuals. This may be accompanied by antitoxin injected into a different area of the body. 2. Proper care of wounds. Surgical débridement to remove the necrotic tissue. 3. Prophylactic use of antitoxin. 4. Antibiotic treatment. Metronidazole *Patients with symptoms of tetanus should receive muscle relaxants, sedation and assisted ventilation. Prevention and treatment
  29. 29. Prophylaxis
  30. 30. THANKS

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