• Clinical science

Gas gangrene (Clostridial myonecrosis)


Gas gangrene (also known as clostridial myonecrosis) is a life-threatening necrotizing soft tissue infection commonly caused by the rapid proliferation and spread of Clostridium perfringens from a contaminated wound. The clinical picture includes excruciating muscle pain, edema with subsequent skin discoloration (red-purple to black) and gas production. Crepitus, as well as a feathering pattern of gas in soft tissue imaging, are generally present. Without treatment, gas gangrene is fatal in almost 100% of cases; surgical debridement in combination with antibiotic therapy reduces this figure by half.



Ubiquitous C. perfringens spores contaminate a wound → bacteria reproduce under anaerobic wound conditions → these bacteria secrete exotoxins, especially Clostridium perfringens alpha toxin, a phospholipase (lecithinase) → degrades phospholipids → tissue destruction, inhibition of leukocyte function, and gas production → the gas separates healthy tissue, which facilitates further colonization and causes more local tissue destructionanaerobic conditions are further exacerbated by the development of edema

Clinical features

Gas gangrene is a medical emergency that can rapidly progress to a severe clinical course with multi-organ failure!


  • Imaging: radiography, CT, or MRI typically show a characteristic feathering pattern of the soft tissue.
  • Laboratory tests
  • Surgical exploration
    • Affected muscle does not bleed or contract, and may be pale or discolored red-purple to black
    • Histopathological findings of biopsy
      • Myonecrosis and destruction of surrounding degenerative tissue (muscle, skin fat, subcutaneous tissue)
      • Presence of organisms; without inflammatory infiltrate [1]

Differential diagnoses

The differential diagnoses listed here are not exhaustive.


The most important steps of management are immediate surgical debridement and antibiotic therapy. Patients should receive supportive therapy and intensive care.