What Is Gas Gangrene?

Gas gangrene is one of the most serious and fastest-growing complications in firearm injuries. If it is not diagnosed and treated in time, it can cause limb loss or life-threatening, with a mortality rate of 20% to 50%. The prevention and treatment of this disease includes early and thorough debridement, opening the wound and preventing its occurrence. Once it occurs, it should be diagnosed early and treated promptly to avoid disability or death.

Basic Information

English name

gasgangrene

Visiting department

surgical

Common causes

Clostridium contaminated wounds, tissue inactivation, local environment

Common symptoms

Uneasy expression, pale skin on lips, fast pulse, anxiety, fear, euphoria

Causes of gas gangrene

There are three main reasons for the occurrence of gas gangrene: Clostridium perfringens, Clostridium perfringens, Clostridium histolyticum and Clostridium histolyticum are contaminated by Clostridium perfringens, among which Clostridium perfringens Bacillus is more common, and mixed infections of several bacteria are more common. Tissue inactivation There are tissues in the wound that are inactive or have blood circulation disorders, especially muscle tissue. local environment Anoxic environment suitable for the growth of anaerobic bacteria.

Clinical manifestations of gas gangrene

Due to the nature of the trauma and the type of bacteria, the incubation period varies in length, the short one is several hours, and the elderly is 5 to 6 days, usually 1 to 4 days.

Systemic symptoms

Appears uneasy early, pale lips, fast pulses, and becomes anxiety, fear, or mental euphoria within hours. Before the infection develops into a severe state, the wounded is always sober, sometimes with an indifferent expression, a pale complexion, and a lot of sweating. The body temperature can reach 38 to 39 ° C, the body temperature and the pulse can be disproportionate, the pulse is 100 to 140 beats per minute, weak and weak. , Rhythm is irregular. With the development of infection, toxemia worsens, and body temperature can reach as high as about 41 ° C. Blood pressure is normal in the early stages and decreases in the later stages. With a decrease in hemoglobin, an increase in white blood cell count. In the later stage, there is severe anemia and dehydration, and sometimes jaundice, resulting in circulatory failure.

Local symptoms

First, the injured limb is heavy and painful, and the dressing or plaster is too tight, and the pain medicine is not effective. Edema around the wound, white indentation left on the finger pressure. There is serous bloody exudate in the wound, which may contain air bubbles. Secretion smear can detect Gram-positive crude bacilli. There is a twist sound on palpation, and the appearance of gas is not consistent, some appear early, and some later are obvious. Clostridium perfringens is the main person, and the gas production is early and more; Otherwise, gas is formed late or no gas. X-ray films show gas shadows in deep soft tissue when air is present.

Wounds often have a stench of hydrogen sulfide. Depending on the strain, it can have different odors such as spicy, sweet and sour, stinky or foul. For example, Clostridium edema infections are not odorous or have a slight odor. Later limbs are highly swollen, blisters appear on the skin, and the skin is brown with marbled markings or black. The muscles bulge from the wound, showing brick red to olive green, and finally black carrion.

Gas gangrene examination

1. Take the wound exudate smear, stain, and microscopic examination, you can see Gram-positive bacillus serovar, single or double arrangement, white blood cells are rarely or deformed, broken, fluorescent antibodies, enzyme-labeled antibodies and enzyme-labeled SPA, etc Staining for rapid identification. It is worth noting that, from a bacteriological point of view, Cp is a Gram-positive bacterium; however, Cp detected from the infected site may be Gram-negative or positive.

2. X-ray examination is helpful for early detection of gas gangrene.

Diagnosis of gas gangrene

The diagnosis of this disease is based on clinical manifestations. The increased pain in trauma or surgical wounds, accompanied by systemic toxic reactions, fever, and gas accumulation in tissues, all support the diagnosis of this disease. The detection of Cp in wounds is of little significance. Clostridium is present in more than 80% of traumatic wounds without evidence of infection. If the amount of gas increases or linear or expands along the muscle and fascial surface, it is suggestive of the disease; At later stages, air accumulation can be seen in the muscle bundle.

Differential diagnosis of gas gangrene

The disease should be distinguished from anaerobic bacteria (including Clostridium or non-Clostridium) cellulitis and anaerobic streptococcal muscle necrosis.

Gas gangrene treatment

Once gas gangrene is diagnosed, surgery should be performed as soon as possible. Even if there is shock, surgery should be performed while the shock is being rescued. Strengthen comprehensive treatment such as systemic supportive therapies, hyperbaric oxygen therapy, and ultraviolet irradiation wounds. Patients with gas gangrene must be treated in situ isolation.

Surgery

(1) Preparation before surgery Anti-shock, blood transfusion, infusion to correct dehydration, electrolyte and acid-base balance disorders.

(2) Surgical methods First, debridement again, and second, amputation is performed for those who have severe symptoms of toxemia and limb necrosis that cannot be kept. When debridement is performed, the wound is fully exposed, a wide range of deep incisions are made, and the necrotic tissue is completely removed until the bleeding healthy tissue can be seen. If the infection is limited to a certain fascial cavity, all affected muscles can be removed and the wound opened. Necrosis of the entire limb, if not amputated will aggravate systemic toxemia, and those at risk of life should decisively amputate. Use high-speed amputation at the normal site. If the amputation site must pass through the affected tissue, the stump skin should be cut open longitudinally, and all remaining affected muscles should be removed from the starting point. The wound is not sutured after amputation. The tourniquet is disabled during surgery. During the operation, the wound was repeatedly rinsed with 3% hydrogen peroxide or 1: 4000 potassium permanganate solution, and the drip was continued; the infusion was continued, and blood transfusion was given as appropriate.

(3) Postoperative care Systemic supportive treatment, proper blood transfusion and fluid infusion, and maintaining a daily urine volume of more than 1500 ml can help the excretion of toxins. Give a digestible, high-nutrition diet. Effective antibiotics such as penicillin are given daily through the vein. The wound was open, and the wound was rinsed with 3% hydrogen peroxide solution once every half hour or continuously dripped into the wound with 1: 4000 potassium permanganate solution until the wound infection was completely controlled.

2. Ultraviolet intense erythema irradiation

Ultraviolet radiation irradiates wounds and has a good effect on this disease. The irradiation range includes 5-10 cm of healthy skin around the wound, the amount is strong erythema, and the amount is reduced after local inflammation control, until it can be used for secondary suture or skin graft.

3. Hyperbaric oxygen

Hyperbaric oxygen therapy is not a substitute for surgery. Hyperbaric oxygen has been used to treat gas gangrene, and satisfactory results have been achieved. 2 to 3 absolute atmospheric pressures, 2 to 4 hours each, 3 times on the first day, 2 times on the second and third days, usually 3 to 4 days L.

Gas gangrene prevention

The fundamental methods to prevent gas gangrene are early thorough debridement, early injection of penicillin, and enhanced systemic supportive therapies. Once this disease occurs, it should be treated in isolation and burned down to avoid cross infection.