Miscellaneous

Gas gangrene: symptoms, photo, treatment, pathogen

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Gas gangrene - a disease caused by anaerobic infection. Often it is seen in gunshot wounds, open wounds or severe injuries, fractures or separating parts of the body and internal organs rupture and other serious injuries. Spreading gangrene depends from global damage sheets and fabrics.

The anaerobic microbes act as a pathogen. Their habitats, as well as the main source of power, are the dead tissue, which inevitably appear in the wounds.

What it is?

Gas gangrene - this is a very serious infectious process that develops as a result of infection of wounds by anaerobic bacteria that live in soil and street dust.

Particularly susceptible to the appearance of gas gangrene patients with extensive wounds, accompanied crush massive muscle tissue, the appearance of pockets and areas with poor blood supply.

Causative agents of gas gangrene

The main causative agent of gas gangrene - Clostridium perfringens. Infektsiyamozhet also be associated with Clostridium septicum, Clostridium histolyticum, Clostridium bifermentans, and others.

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Clostridium perfringens refers to anaerobic organisms, fully adapted to live in oxygen-free conditions. Lives in soil, animal feces, sewage - wherever they may enter the human or animal intestine. Clostridium long time can survive, because they form a protective capsule for the stability in the external environment. Furthermore, Clostridium adapted to survive in extreme conditions, sufficiently resistant to high and low temperatures, UV, chemical disinfectants.

Clostridial toxin entering the digestive tract via contaminated food, causes severe intoxication, which can end fatally.

Wounds infected with Clostridium perfringens, may cause gangrene. An important prerequisite for this is a lack of oxygen to the wound access and arterial blood. Typically, these lesions are from sharp, thin object (knife, awl, nail), which penetrate deep into the tissue, without affecting the large vessels and causing heavy bleeding. If the wound leaked large amounts of blood, most likely it is cleared naturally by all organisms. Another possibility of favorable conditions for the breeding of clostridia - extensive laceration, with areas separated tissues deprived of blood supply, fascial pockets. Such conditions can be created in the wounds of the lower extremities. Infected Wounds clostridia often occurs with soil or animal feces.

The most favorable environment for the reproduction of Clostridium perfringens - pH 7.2-7.4; presence of glucose, protein; the absence of oxygen; t 39-43 ° C. Diagnostic criteria of having a wound clostridial is allocation by gas chromatography, propionic, butyric, acetic acid.

Classification

The character of the disease depends on the species of pathogen infection - Clostridium. Distinguish types of gas gangrene:

The classical form It characterized by the presence of large amounts of gas, the absence of purulent secretions and moderate swelling. With the increase of muscle damage limb becomes brown. Increase intoxication causes the disappearance of the pulse on the local peripheral arteries.
Putridnaya (putrefactive) form The name came through adherence to pathogen infection of anaerobic clostridia - spoilage microorganisms. Characterized by a high degree of lesion, rapid flow - instantly applied to tissue and muscle, extensive necrosis develops. With pus from the wound allocated chunks necrotic tissue. The destruction of the arteries is accompanied by bleeding.
Abscess form. The easiest form. It differs little swelling, pus with gas bubbles. Muscles in the area of ​​damage to the pink with small areas of necrosis. The skin is warm without changing the color, the pulse is stored.
Edematous-toxic form. Edema develops immediately, the gas discharge is small, no pus. Subcutaneous tissue acquires a greenish tint, the pulse disappears at the local peripheral arteries.

Patients with infectious myonecrosis and pose a threat to others - in order to avoid transmission to be isolated from other patients of infection. In the open space of clostridia are not viable, but the infection can be transmitted with spores of microorganisms. Patient treatment needed clothes and tools, air sterilization in Ovens, reboiling. Dressing the patient's infectious - it burned. Transmission routes of gas gangrene - wound. the risk of infection exists for people after the injury, injections, surgery, abortion.

Symptoms gas gangrene

Gas gangrene is characterized by a number of specific symptoms (see. photo), some of which are pathognomonic; most of them aimed at identifying the resulting gas:

  1. Symptom spatula - metal spatula when tapped on the affected area can hear the characteristic crisp, with the sound of the tympanic shade. The same sound can be heard when shaving the skin around the wound (symptom Razor).
  2. Symptom ligatures (Melnikova sign) - when applied to the site ligature limbs 15-20 minutes thread begins to dig into the skin due to the swelling of the limbs.
  3. Symptom Krause - intermuscular gas accumulations on x-rays are visualized in the form of "firs".
  4. Symptom champagne cork - the extraction pad (swipe) popping sound from the wound turn.

Within 6 hours after acquisition of the ability to infect germ arise general state violations with tachycardia and fever. Skin gray-blue color. Rana sharply painful, the edge of her pale, swollen, lifeless, dry the bottom of the wound. Coloring visible in the wound muscles reminiscent of boiled meat. When pressure is applied to tissue from the wound edges are allocated the gas bubbles having an unpleasant sweet-putrid smell. When probing defined typical pohrustyvanie (crepitus). The patient's condition is deteriorating rapidly, the shock occurs.

stage of the disease

Gas gangrene has four stages

  1. In the early stage (delimited gas gangrene) patients complain of pain. Wound dry with a dirty gray plaque necrosis with little or no discharge or with a small amount of brownish exudate. Edema was observed only around the wound, the skin in this area busy, shiny, with a slight pale jaundiced ( "white edema", "white mug").
  2. Step propagation process in the progression of edema and increased gas formation occurs spread their extremities. The character of the pain, it becomes bursting. Tissue in the wound becoming lifeless appearance, dry, muscles vybuhayut from the wound, dull, brittle, bloodless. Yellowness pale-color of the skin from the wound widely distributed in the affected area is observed bronze or marble stain.
  3. In the third step limb becomes cold, peripheral pulsation is not detected, it stops the pain, disturbed its sensitivity. The finiteness of the pale, sharply increased in size; edema and gases are distributed on the trunk, register bubbles with brown or hemorrhagic exudates. Rana lifeless, the muscles in her kind of "boiled meat" from the depths of the wound may krovjanisto-purulent discharge.
  4. In the fourth step (sepsis) in the wound purulent discharge, there is a pronounced intoxication, purulent distant metastatic lesions.

Early symptoms of anaerobic infections: patients expressed concern, excitement, loquacity, followed at lethargy, weakness, impaired orientation in time and space, increased body temperature, tachycardia, and hypotension. With the progression of the process is characterized by the development of hepatic-renal failure, leading to hepatocellular jaundice, increasing because of the toxic hemolysis, oliguria and anuria.

Diagnostics

Diagnosis is based on a characteristic wounds of intoxication.

Diagnosis is confirmed radiographically (determined by the "porosity" of muscle tissue) and microscopically (detection of a clostridial of wound). The differential diagnosis is carried out by the fascial gassing phlegmon (no muscle damage) and putridnoy (putrid) infection.

Treatment gas gangrene

Patients with gas gangrene isolated, they emit a single nursing unit, dressing immediately burn, tools and linen are subjected to special treatment.

Clostridia spores are highly resistant to boiling, so the tool should be treated in pressurized conditions in a steam sterilizer or in a heat cabinet. Any medical actions to be undertaken in rubber gloves, which is burned after the procedure, or immersed in a disinfectant composition (Lysol, carbolic acid, chloramine).

Pathogenetic therapy complex includes the following components:

  • adequate sanitation surgical wounds;
  • preventing bacterial multiplication and spread of infection via the oxygenation chamber, the use of antibacterial agents and specific sera;
  • correction changes the functions of organs and systems using infusion and anticoagulant therapy, immunostimulation and immunomodulation;
  • neutralizing the action of toxin circulating the introduction of specific toxoids and use of methods of extracorporeal detoxification.

The main condition for the prevention of gas gangrene - a timely first debridement (PECVD) with excision of necrotic tissue. This operation is usually performed under general anesthesia. Also affected are introduced protivogangrenoznuyu serum, but experience has shown that reliance on the effectiveness of these funds is not justified. In addition, it is the introduction of serum often provokes serious complications, up to the development of anaphylactic shock.

Since anaerobic bacteria sensitive to antibiotics, in patients with extensive wounds, even after full CVD, designate complex treatment gas gangrene using local and general therapy broad spectrum antibiotics actions.

Operation

Surgical treatment includes:

  • excision of compromised tissues (non-viable and dead); no question of sparing surgery is not - should handle all suspicious areas;
  • cut at all possible depths of tissue and fascia surrounding the wound (since anaerobic infection are killed when exposed to oxygen). These sections are called lampasnymi. The relative length of a wide barrier surgery may serve except large blood vessels and nerve trunks, but threat the patient's life, established gas gangrene, prefer to radically open fabric with a stop bleeding necessary);
  • maximal drainage for adequate outflow discharge from the wound; must be drained each "pocket" in the tissues;
  • it is extremely important: the bandage is not applied, the wound should be open;
  • and bottom edges of the wound with antibiotics need to be processed;
  • if compromised limb tissue, and diagnosis of the disease is confirmed, with further distribution gas gangrene in urgent procedure requires limb amputation or disarticulation (amputation at the level joint). Wound after such operation can not sew.

As an adjunct to surgery is a hyperbaric oxygen - the oxygen saturation of the patient's body. For this purpose, the patient is placed in a chamber in which up to 3 atmospheres of elevated pressure. Sessions last for 2-2.5 hours - the first day at least 3 times, then 1 times a day. Hyperbaric oxygen therapy in any case should not be considered as an alternative method that should be used instead of surgery.

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