Gangrene, Gas gangrene and necrotizing fasciitis


Gangrene is the death of tissue due to ischaemia. It can be divided into:
  • dry gangrene = ischaemia only
  • wet gangrene = ischaemia plus infection.

Treatment is debridement and antibiotics.

Necrotizing fasciitis

Necrotizing fasciitis is severe infection of the deep soft tissue, including fascia. 50% of patients have a skin injury prior to developing necrotizing fasciitis. Early presentation is erythema, swelling, and pain out of proportion to the presentation.

2 types
  • Type 1: polymicrobial
  • Type 2: group A streptococcus (strep pyogenes) and staphylococcus aureus
Treatment is surgical debridement and antibiotics
Mortality is around 25%

Fournier’s gangrene = Form of infective necrotising fasciitis of the perineal, genital or perianal regions Increased risk in those with diabetes, alcoholism or other immunosupression

Meleney’s gangrene = Form of gangrene that occurs postoperatively

Gas Gangrene
Gas gangrene is a necrotizing infection characterised by muscle necrosis, gas production and often septic shock.  It is most commonly caused by clostridium perfringens, which is a gram negative rod.  Most cases follow a contaminated traumatic injury (e.g. a farmer on a pitchfork) but occasionally cases can be spontaneous.  Treatment is urgent surgical debridement and antibiotics.

Small print gem: Around 10% of patients with clostridial infections have an underlying malignancy.                 

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