Gas Gangrene (myositis or myonecrosis)
Definition and Causes
Gas gangrene, also called clostridial myositis or myonecrosis, is a severe and rapidly spreading infection of muscle and other soft tissue.
More than 20 different clostridial exotoxins have been identified, nine of which are implicated in the local and systemic changes seen in gas gangrene; alpha-toxin, theta-toxin, kappa- toxin, mu-toxin, nu-toxin, fibrinolysin, neuraminidase, "circulating factor," and "bursting factor."
The bacteria that cause gas gangrene, of the species clostridium, most commonly, Clostridium perfringens, produce liquid and gaseous poisons (toxins) that inflame (myositis) or kill (myonecrosis) healthy tissue. The advancing infection can threaten life and limb in mere hours.
Flesh-eating clostridium and other bacteria may originate in the gut, contaminated food, surgical incisions, community and healthcare environments, or soil embedded in traumatic wounds and bone fractures.
For the induction of gas gangrene, two conditions have to be fulfilled:
The presence of clostridial spores and An area of lowered oxidation?reduction potential caused by circulatory failure in a local area or by extensive soft tissue damage and necrotic muscle tissue. This condition results in an area with a low O2 tension where clostridial spores can develop into the vegetative form.
The microorganisms surround themselves with toxins (alpha- or a-toxins) that interfere with the body’s natural immune response. Stopping toxin production as soon as possible is essential to prevent tissue loss, amputation, shock, and death.
Treatment with Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy, combined with antibiotics and surgical removal of dead tissue, is an effective treatment for gas gangrene. Clostridia are anaerobic, meaning they thrive in low-oxygen environments.
HBOT stops toxin production and inhibits bacteria from replicating and spreading. Hyperbaric oxygen may also boost the effect of antibiotics, enhance the body’s natural defenses against bacteria, and help resolve or delay the onset of sepsis, a deadly blood poisoning.
Undersea and Hyperbaric Medical Society
The advantages of early HBO2 treatment are that:
It is life-saving because less heroic surgery needs to be performed in gravely ill patients and the cessation of alpha-toxin production is rapid.
It is limb and tissue-saving because no major amputations or excisions are done prematurely (except opening of wounds).
It clarifies the demarcation, so that within 24-30 hours there is a clear distinction between dead and still-living tissue. In this way, both the number and the extent of amputations are reduced.In 1984 Peirce already concluded that the modern treatment of gas gangrene involves the simultaneous use of antibiotics, surgical debridement and hyperbaric oxygen.
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