Management of clostridial gas gangrene and the role of hyperbaric oxygen.
OBJECTIVE
Clostridial gas gangrene is one of the most dreaded infections in surgery. The aim of this study was to investigate the efficacy of surgery, antibiotic treatment, surgical intensive care and especially the role of hyperbaric oxygen in the management of clostridial gas gangrene.


METHODS
53 patients, 42 of them submitted from other hospitals in Finland. After the diagnosis had been made the patients underwent surgical debridement, broad spectrum antibiotic therapy and a series of hyperbaric oxygen (HBO) treatments at 2.5 ATA pressure. The necrotic tissue was excised and incisions were made in the affected areas. Amputations were performed when necessary.


RESULTS
Twelve patients died (22.6%). Hyperbaric oxygen therapy decreased the systemic toxicity and prevented further extension of the infection thereby improving the overall outcome of the patients.


CONCLUSIONS
Hyperbaric oxygen therapy of gas gangrene seems to be life-, limb- and tissue saving. Early diagnosis remains essential. Patient survival can be improved if the disease is recognized early and appropriate therapy applied promptly. Surgical and antibiotic therapy as well as HBO treatment combined with surgical intensive care must be started as soon as possible.
Department of Surgery, University of Turku, Finland.
K
K
Korhonen
J
J
Klossner
M
M
Hirn
J
J
Niinikoski
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D005738:Gas Gangrene / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents