‫بسم هللا الرحمن الرحیم‬

‫موضوع کنفرانس گازگانگرن‬

‫تاریخ کنفرانس سال ‪1388‬‬

 Cell Death
• Necrosis
1. Coagulation necrosis or Ischemic
necrosis
2. Liquifactive necrosis
3. Caseous necrosis
4. Gumatous necrosis
 Fat necrosis
Traumatic fat necrosis Enzymatic fat necrosis
 Gangrene
• Definition

gangrene
Wet gangrene Dry gangrene
 Risk factor for increasing
wound infection
1. Malnutrition (obesity and weight loss)
2. Metabolic diseases (Diabetes , uremia
,jaundice)
3. Immunosuppression (Cancer, AIDS ,Steroid
,chemotherapy ,Radiotherapy)
4. Colonization and translocation in the GI
tract
5. Foreign body
6. Poor surgical techniqe(dead space and
heamatoma)
Definition of infected state
• SSSI (superficial surgical site
infection )
• SIRS (systemic inflammatory
response syndrome)
• MODS ( multiple organ failure
syndrome)
• MSOF (multiple system organ failure)
Gasgangren
 Alternative name
• Gas myonecrosis
• Return to top
• Clostridial gangrene

Definition
Etiology
 ‫اسباب‬
• Penetrating war wound
• Trauma
• Recent surgical wound for colorectal
and billary tree operations
• After abortion
• Puerperone or post partum infection
 1/3 spontaneously
•Colon cancer
•Diabetes mellitus due to atherosclerosis
•Leukemia
•Immunosuppression
High risk wound
Crush wound with dead tissue
Wound contamination with soil or faceas
Open fracture and frostbite
 Pathophysiology
• Clostridium perfringense
(Cl.welchii)
• Clostridium septicum
• Clostridium oedemateine ( Novyi)
• Clostridium sporogense
 Toxin
• Alpha
• Beta
• Epsilon
• Iota
Effects
1. Destroy local tissue
2. Heamolysis
3. Local ischemia (vasoconstruction)
4. Increase vascular permeability
 Gas production
Proteolytic and succrolytic

1. Protease
2. hyaloronidase
3. Leceithinase
4. glycogenase
 Gas analysis
• Hydrogen 5.9%
• Carbondioxid 3.4%
• Nitrogen 74.5%
• Oxygen 16.1% in one
clinical cause.

In general it produce : NH3 ,CO2

,H2S due to protein catabolism
 Clinical feature
• Simple contamination
• Gas abscess (wellchii’ s
abscess)
• Clostridial cellulites
• Localized clostridial Myositis
• Diffuse clostridial Myositis
Simple contamination
Creptent clostridial cellulites
Gas abscess
Localized clostridial Myositis
Diffuse cellulites clostridial
Myositis (Gas gangrene)
Oedematous gangrene
Sign and symptom
1. Air under skin or subcutaneous emphysema
2. Anxeity
3. Blister filled with brown-red fluid
4. Foul smelling –brown red or bloody drainage
serosanguineous discharge
5. Tachycardia
6. Fever
7. Pale skin color later become dusky and change
to dark red or purple
8. Sever pain
9. Progressive swelling
10. Vesicle formation with large blister
11. Yellow skin color or jaundice
12. sweating
Exam and tests
Gram stain
 Differential diagnosis
• Synergistic spreading hospital gangrene

Necrotizing facititis
1. Staphylococcus
2. Anaerobic streptococcus
3. Peptostreptococcus
4. Bactriod
5. cokiform
Necrotizing facititis
Meleney’s synergistic hospital
gangrene
Fournier's gangrene
Fournier's gangrene
 Treatment
• Surgical treatment
• Hyperbaric oxygenation
• Antibiotic therapy
• penicillin crystal 5-10M unit/4h
• Metronidazole 500mg/8h
• Clandomycine 600mg/6h
• Ampecilline 1gr/6h
• Clandomycine 600mg /6h
• Gentomycine 80mg/12h
OR
1. Vancomycine 1gr/8h
2. Metronidazole 500mg/8h
3. Gentomycine 8omg/12h

Analgesic for pain management

 Possible complication
1. Shock
2. Jaundice with liver damage
3. Kidney failure
4. Stupor
5. Delirium
6. Coma
7. And finally death
 Prognosis
prevention
1. Cleaning of wound
2. Remove of foreign body
3. Opening of pressure bandage or plaster
cost
4. Early amputation or opening of wound
5. Antibiotic use
‫تشکر‬