Gas Gangrene in Orthopaedic

Patients
Preklinik UWKS A
Ingenio Learning Centre
Surabaya
INTRODUCTION

GAS GANGRENE

DIFFICULTIES IN CLOSTRIDIAL
DIAGNOSIS MYONECROSIS

POST-
TRAUMATIC
POST-
OPERATIVE

SPONTANEOUS
CASE REPORT
LABORATORIUM EXAMINATION
 WBC 22.2 X 109/L
 HB 83 g/L
 TROMBOSIT 183 X 109/L
 SERUM GLUCOSE 324 mg/dL
 C-reactive protein 48.0 mg/dL
 Serum Creatinine 155 µmol/L
 Needle Aspirated  gram-positive bacilli
PLANNING THERAPY (ER)
 Broad Spectrum Antibiotics: (IV)
 Penicillin
 Clindamycin
 Metronidazole
 Fluid Resuscitation
 Urgent Surgery
DATA
DATA
DATA
DATA
OUTCOME
DISCUSSION
 GAS GANGRENE:
 CLOSTRIDIAL MYONECROSIS
 LOCALIZED
 DIFFUSE
 CLOSTRIDIAL CELLULITIS
 NON-CLOSTRIDIAL
DISCUSSION

CLOSTRDIAL CLOSTRIDIAL
CELLULITIS MYONECROSIS

• Sedikit nyeri • Nyeri tajam

• Edema – • Edema +
• Systemic Toxicity • Systemic toxicity
rendah tinggi
• Gradual onset • Onset cepat
• epifascial • myonecrosis
DISCUSSION

C.PERFRINGENS C.SEPTICUM

AFTER SURGICAL
PROCEDURES

• UNDERLYING MALIGNANCIES
• HEMATOLOGICAL SOLID TUMOR
• GI SOLID TUMOR
• DM
• ATHEROSCLEROTIC DISEASE
• SEVERE PERIPHERAL VASCULAR
DISEASE
DISCUSSION
 Gas gangrene: Acute and Life threatening infection
 Fever
 Sudden onset of prominent pain (not relieve with pain killer)
 Massive local edema
 Severe extensive myonecrosis
 Accumulation of gas at the site of infection
 Bronze skin  purplish red skin and multiple hemorrhagic
bullae
DISCUSSION
 TREATMENT:
 SUPPORTIVE MEASURES
 ANTIMICROBAL THERAPY
 TIMELY SURGICAL INTERVENTION
 RADICAL AMPUTATION (BEST CHOICE OF TREATMENT)
 HBOT  ?
 IF NOT CONTROLLED WELL ?
 SYSTEMIC TOXEMIA
 HYPOTENSION
 SHOCK
 MULTIORGAN FAILURE
 DEATH
CONCLUSION
 Aware of gas gangrene
 Strict aseptic techniques
 Meticulous wound debridement + Delayed Closure
 Once gas gangrene diagnosed, debridement should be
institued immediately
 Systemic Resuscitative
 Gas gangrene may occur spontaneously and often in
immunocompromised patient, post-operative wound may
also develop gas gangrene due to the local soft tissue damage
and decreasing blood suply