Gas Gangrene

Gas gangrene is acute, rapidly progressing, and not pus-producing. Effects can be both local and systemic. Gangrene can occur with compound fractures, complicated fractures, extensive soft tissue injury after street accidents, war wounds, and appendicitis. Many marine organisms can cause gangrenous infections that begin with only a small cut or scrape while swimming, surfing, or diving. People with liver disease, diabetes, who are immunocompromised or taking immunosuppressive medication are at increased risk. Symptoms of clostridial gangrene occur 1 to 6 hours after injury, with severe and sudden pain in the infected area. Skin overlaying the wound appears shiny and tense in the early phases, then dusky, progressing to bronze. It can advance at a rate of 6 inches per hour (fast). Exotoxin causes vasodilation and vascular collapse. Pronounced swelling and edema occur in the infected area. Hemorrhagic bullae (large bleeding blisters) or vesicles may be noted. Muscles appear dark red to black or greenish, are noncontractile and do not bleed when cut. Destruction may be localized to a small area or involve an entire extremity or organ (such as the bowel) and may be wet or dry. The person is usually very sick. A physician needs to immediately examine the patient if Gangrene of any kind is suspected. Delay in recognition or treatment can be limb-threatening or fatal. Early treatment is vital.

Benefits From Hyperbaric Oxygen Treatment

  • Exotoxin production stops if tissue partial pressure is higher than approximately 300mmHg.
  • Compression reduces gas bubble size and tissue pressure, improving perfusion and reducing pain. HBOT is considered life-saving because less "heroic" surgery is needed in gravely ill patients, and the alpha-toxin production is rapidly stopped.
  • HBOT is limb and tissue saving because no major amputations or excisions are done prematurely. It clarifies the demarcation, so that within 24 to 30 hours there is a clear distinction between dead and still living tissue.
  • Brummelkamp et al (1961) showed that HBOT inhibited toxin production, which stops at tissue oxygenation of 60 mmHg and above.
    • Hart et al(1983) had 139 cases of Gas Gangrene, with limb salvage rate of 80%.
    • Bakker (1988) Out of 409 cases of Gas Gangrene, the amputation rate was on 8.7% after HBOT treatments.