Management of clostridial gas gangrene and the role of hyperbaric oxygen

Background and Aims: Clostridial gas gangrene is one of the most dreaded in fections in surgery. The aim of this study was to investigate the efficacy of surgery, antibiotic treatment, surgical intensive care and especially th e role of hyperbaric oxygen in the management of clostridial gas gangrene. Material and Methods: 53 patients, 42 of them submitted from other hospital s in Finland. After the diagnosis had been made the patients underwent surg ical debridement, broad spectrum antibiotic therapy and a series of hyperba ric oxygen (HBO) treatments at 2.5 ATA pressure. The necrotic tissue was ex cised and incisions were made in the affected areas. Amputations were perfo rmed when necessary. Results: Twelve patients died (22.6 %). Hyperbaric oxygen therapy decreased the systemic toxicity and prevented further extension of the infection the reby improving the overall outcome of the patients. Conclusion: Hyperbaric oxygen therapy of gas gangrene seems to be life-, li mb- and tissue saving. Early diagnosis remains essential, patient survival can be improved if the disease is recognized early and appropriate therapy applied promptly. Surgical and antibiotic theraby as well as HBO treatment combined with surgical intensive care must be started as soon as possible.