A 45 year old female is brought to the emergency room with crush injury of thigh following a motor vehicle accident. Best method to prevent gas gangrene is
Answer: a) Thorough wound debridement (HARRISON 19TH ED, P-2077)GAS GANGRENEClostridial myonecrosis/Malignant edema/Anaerobic myositisUsually several species of Clostridia are involved along with E coli, proteus and staphylococciCl perfringens causes 60% of the cases; Most commonly by type ARemaining cases are caused by Cl septicum, Cl novyi and Cl histolyticumThe incubation period can be as short as 6 hours and is usually <4 daysMost important factor needed - low oxygen tensionPain and crepitusPatients frequently develop marked tachycardia, but in temperature may be only minimalNear absence of PMNs despite extensive tissue destruction is characteristicDiagnosisFrozen section biopsy of muscleReverse CAMP test - to identify Cl. perfringensGram staining:G+ bacilli without spores - Cl.perfringensCitron bodies and boat or leaf shaped bacilli - Cl.septicumLarge bacilli with oval or subterminal spores - Cl.novyiTreatmentSurgery debridement of the wound - mainstay of prophylaxis & treatmentClindamycin or metronidazole + penicillinHyperbaric O2Anti-gas gangrene serum - uncertain efficacy, not widely available, rarely used now
Thorough wound debridement
Hyperbaric oxygen therapy for wound
Anti-gas gangrene serum
Tetanus immunoglobulin
Wounds, Tissue Repair & Scars