TAILIEUCHUNG - Chapter 135. Gas Gangrene and Other Clostridial Infections (Part 4)

Gas Gangrene (Clostridial Myonecrosis) Gas gangrene is characterized by rapid and extensive necrosis of muscle accompanied by gas formation and systemic toxicity and occurs when bacteria invade healthy muscle from adjacent traumatized muscle or soft tissue. The infection originates in a wound contaminated with clostridia. Although 30% of deep wounds are infected with clostridia, the incidence of clostridial myonecrosis is quite low. These infections occur in both military and civilian settings. An essential factor in the genesis of gas gangrene appears to be trauma, particularly involving deep muscle laceration. The entity of clostridial myonecrosis is relatively uncommon after simple,. | Chapter 135. Gas Gangrene and Other Clostridial Infections Part 4 Gas Gangrene Clostridial Myonecrosis Gas gangrene is characterized by rapid and extensive necrosis of muscle accompanied by gas formation and systemic toxicity and occurs when bacteria invade healthy muscle from adjacent traumatized muscle or soft tissue. The infection originates in a wound contaminated with clostridia. Although 30 of deep wounds are infected with clostridia the incidence of clostridial myonecrosis is quite low. These infections occur in both military and civilian settings. An essential factor in the genesis of gas gangrene appears to be trauma particularly involving deep muscle laceration. The entity of clostridial myonecrosis is relatively uncommon after simple through-and-through bullet wounds without shattering of bone and is relatively common after shrapnel fragmentation wounds particularly when deep muscle is involved. In civilian cases gas gangrene can follow trauma surgery or IM injection. The trauma need not be severe however the wound must be deep necrotic and without communication to the surface. Indeed seeding of muscle tissue by C. septicum from a gastrointestinal source often a malignancy may lead to spontaneous nontraumatic clostridial myonecrosis Fig. 135-1 . The incubation period of gas gangrene is usually short almost always 3 days and frequently 24 h. Some 80 of cases are caused by C. perfringens while C. novyi C. septicum and C. histolyticum cause most of the remaining cases. Typically gas gangrene begins with the sudden onset of pain in the region of the wound which helps to differentiate it from spreading cellulitis. Once established the pain increases steadily in severity but remains localized to the infected area and spreads only if the infection spreads. Soon after pain develops local swelling and edema accompanied by a thin often hemorrhagic exudate appear. Patients frequently develop marked tachycardia but elevation in temperature may be only minimal. Gas .

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