Limb salvage after gas gangrene: a case report and review of the literature.

John Aggelidakis,John Koutroumpas,Georgios Kouvidis,Anastasia Topalidou,Paulos Katonis,Konstantinos Lasithiotakis

doi:10.1186/1749-7922-6-28

Abstract

Gas gangrene is a necrotic infection of soft tissue associated with high mortality, often necessitating amputation in order to control the infection. Herein we present a case of gas gangrene of the arm in an intravenous drug user with a history of intramuscular injections with normal saline in the shoulder used to provoke pain for recovery after drug induced coma. The patient was early treated with surgery and antibiotics rendering possible the preservation of the limb and some of its function. Additionally, a review of the literature regarding case reports of limb salvage after gas gangrene is presented.

Highlights

Gas gangrene or Clostridial myonecrosis is a necrotic infection of skin and soft tissue and it is characterized by the presence of gas under the skin which is produced by Clostridium
Gas gangrene of the limbs is a rare infection due to anaerobe bacteria associated with high morbidity and mortality
Intravenous drug users are considered at high risk for gas gangrene and it has been shown that Clostridia are able to survive in heroin preparations being mixed with citric acid and heated [2]

Summary

Background

Gas gangrene or Clostridial myonecrosis is a necrotic infection of skin and soft tissue and it is characterized by the presence of gas under the skin which is produced by Clostridium. We report a case of gas gangrene which was treated early with surgical debridement and enabled salvage of the limb with significant preservation of its function. Surgical debridement with resection of additional necrotic tissue was performed in the intensive care unit. His temperature returned to normal on postoperative day 10 and his general condition was gradually improved thereafter. Review of cases reported in the literature This review included Medline reported adult cases of limb salvage following gas gangrene (clostridial myonecrosis) until June 2011. Functional status of the salvaged limb was reported in eight cases, five of them regaining normal function of the affected limb

Discussion

Findings

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