Gas Gangrene

Gas gangrene is a lethal bacterial myonecrosis caused by the Clostridium species. It is associated with high morbidity and mortality, but, fortunately, is rare in children. Gas gangrene is commonly associated with high-velocity injuries with severe soft tissue involvement. Occasionally, it arises without an obvious history of trauma. Symptoms may be non-specific. It should be suspected if there is sudden onset of severe persistent pain, tender tense swelling of muscle with hemorrhagic exudate, and systemic signs of septic shock. The typical radiological features are gas in the myofascial plane; conversely, it is absent in early stages of the disease. It must be recognized early, and intervention should be done promptly to minimize mortality. Aggressive medical management, including crystalloid fluid and antibiotics, must be started early. The role of antitoxin and hyperbaric oxygenation is debatable but, at best, remains supportive. Debridement and fasciotomy should be done early as limb salvage surgery. Amputation should be done in late presenting fulminant infection to preserve life. The combination of early, aggressive surgical treatment with parenteral antibiotics and supportive medical management is the cornerstone of gas gangrene treatment. The mortality is lower than previous reports due to advancement in treatment of these disorders.