|Causes||Tissue hypoxia, traumatic muscle injury and bacterial contamination are major causes. These infection can affect widespread areas involving various parts of the body and is mainly caused by Clostridial bacteria|
|Clostridial myonecrosis||Clostridial myonecrosis (‘gas gangrene’) is caused by anaerobic bacteria, which thrive in low oxygen levels. This occurs in:
Often, there is also reduced immunity, from chronic illness or malnutrition.
|Symptoms||After the initial trauma, a short period of incubation usually follows. Local signs include:
The alpha-exotoxin, produced by the clostridial bacterium, causes local toxicity, including tissue necrosis and haemolysis. It also affects other organs of the body, causing:
Other toxins (q,k,µ) are produced by the bacteria: these may cause local and distant harm.
|Necrotizing faciitis||Necrotizing faciitis sometimes called Fourniers gangrene (for scrotum and penis).
Subcutaneous (anaerobic) infection spreading along the deep fascia (layer covering the muscles), causing secondary skin lesions and sparing muscles until the late stages of the infection.Symptoms as described above.
|Treatment||Septic shock, acute kidney, or respiratory failures sometimes associated with these conditions require conventional intensive care treatment.
Antibiotic Therapy – Penecillin is the antibiotic of choice for treating and preventing anaerobic infections.
Surgery – Before antibiotics, mutilating surgery, involving amputation at the root of the limb, could save a patient’s life if carried out early on before the infection spread. With the development of antibiotics and HBO therapies, surgery is now used to eliminate necrotic tissue and reduce oedema related compression.
Hyperbaric Oxygen Therapy – The management of these infections includes Hyperbaric Oxygen, adjunctive to general resuscitation, intensive care, surgery and antibiotics. The order in which they are given is dictated by the patient’s condition; however, if Hyperbaric Oxygen can be given before or during surgery, the patient’s general condition can be improved by reducing the level of exotoxin. The use of Hyperbaric Oxygen is determined by the patient’s general condition rather than the local infection.
|Duration of HBO treatment||Standard treatment at LHM involves 2-4 sessions of Hyperbaric Oxygen Therapy administered on a daily basis, before and after surgery. Individual sessions last approximately 2 hrs 45 minutes with patient breathing oxygen for 150 minutes at 3.0 atmospheres.|
|Evidence/References for HBO||1.Bakker D.J. ‘Pure and mixed aerobic and anaerobic soft tissue infections. Classification and role of Hyperbaric oxygen treatment. HBO Rev., 1985, 6, 65-96
2. Mathieu D. (Ed.) Handbook on Hyperbaric Medicine, 263-289. Springer 2006