- Clinical science
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.
Path of infection
- Ubiquitous clostridial spores contaminate the wound
- Wounds with compromised blood supply create an anaerobic environment → optimal for the proliferation of C. perfringens → necrosis progresses within 24–36 hours. Such wounds include:
Ubiquitous C. perfringens spores contaminate a wound → bacteria reproduce under anaerobic wound conditions → these bacteria secrete exotoxins, especially alpha toxin, a phospholipase → 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 destruction → anaerobic conditions are further exacerbated by the development of edema
- Incubation period: hours to days
- Local signs and symptoms
- Systemic toxicity
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.
- Gram staining: large, gram-positive rods
- 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 
The most important steps of management are immediate surgical debridement and antibiotic therapy. Patients should receive supportive therapy and intensive care.
- Surgical exploration and debridement: If applicable, amputation of the affected extremity may be necessary.
- Antibiotic therapy: penicillin plus clindamycin or tetracycline 
- Assessment of compartment pressure if compartment syndrome is suspected
- Hyperbaric oxygenation use is controversial
- Tetanus toxoid if indicated
Case fatality rate
- Untreated: up to 100%!
- With appropriate treatment: up to 50%!