Clostridial Myonecrosis Gas Gangrene

Definition

• Life-threatening, fulminant clostridial infection of skeletal muscle

• Usually muscle trauma wound contamination with clostridial spores

• Most commonly C. perfringens or sepucum • malignancy (heme or Gl) Clinical manifestations

• Acute onset with sense of heaviness or pain, often at site of trauma or surg. that rapidly

T's with marked systemic toxicity

• Bronze discoloration of skin, tense bullae, serosanguineous or dark fluid and necrotic areas

• Crepitus present but not prominent (gas is in muscle) may be obscured by edema Diagnostic studies

• Gram stain of discharge: large, Gram i) bacilli with blunt ends, very few polys

• Clostridial bacteremia in -15%

• Plain radiographs: gas dissecting into muscle

Treatment

• Surgical exploration with debridement, fasciotomies, and amputation if necessary

• Antibiotics: high-dose penicillin G 24 MU IV divided q2-3h + clinda 900 mg IV q8h

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