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Gas Gangrene

Qualifications

Clostridial myonecrosis or spreading clostridial dellulitis with systemic toxicity - or a presumptive diagnosis of either.

Hyperbaric oxygen is to be used as an adjunct to surgery and antibiotic treatment.

Rationale

Gas ganrene is caused by any of six pathogenic clostridial organisms which are able to grow and produce tissue necrotizing toxin in humans. Ninety percent of cases are caused by Clostridium perfringens. Clostridium perfringens grows rapidly in oxygen tensions below 300 mmHg. Restricted growth is seen in oxygen tensions of 70 mmHg, and oxygen tensions of 250 mmHg stop alphatoxin production. It is important that hyperbaric oxygen be started early and continued until progress of the anaerobic infection is clearly stopped. A minimum of five HBO treatments is recommended. Hyperbaric oxygen must be started on the basis of surgical impression and demonstration of clostridial organisms on gram stained smear of involved tissue. By elevation of wound oxygen tension in the region of functioning capillaries in the infected wound, further toxin production is stopped and necrotic tissue than otherwise possible. Initially, fasciotomy, when indicated, should precede hyperbaric oxygen treatments. The need for emergency life-saving ablative surgery is obviated as hyperbaric oxygen stops further progression.

Cost Impact

Reduction of morbidity, prevention of amputation, or at least lowering the level of amputation required in limb gas gangrene, justify the costs. Treatment extending beyond a few days is seldom, if ever required.

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