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gas gangrene[¦gas ′gaŋ‚grēn]
gas phlegmon, malignant edema, Antonov’s fire, a severe acute infectious disease caused by several microbial clostridia (Cl. perfringens, Cl. septicum, Cl. oedematiens, Cl. histolyticum) that grow without access to oxygen (anaerobic infection). It arises in deep, lacerated, and crushed extensive wounds that have pockets and recesses and in which the local blood circulation has been disrupted. It is particularly common in wartime and occurs almost exclusively in the limbs (usually the legs). It affects all soft tissues but mainly fatty tissue and muscles. The classical symptoms of inflammation are absent in gas gangrene. The process is characterized by progressive edema, gas formation in the tissues, poor general condition, and necrosis caused by the specific toxins of the causative agents of the disease and by the products of tissue breakdown. The incubation period is 3-5 days. The affected limb quickly swells. Two phases are distinguished according to the local changes in the course of the process: edema formation and the development of gas gangrene. In the latter, gas is produced in the dying tissues. The edema is the tissue reaction to the toxins, and the gas is the result of the decomposition of muscle glycogen and protein by the toxins.
Severe bursting pain develops at the site of gas gangrene and edema in the wound. The skin at first is pale and then becomes covered with brown, bronze, or blue spots; it is cold to the touch. In the classical emphysematous form, gas formation predominates over the edema. The wound is dry, and gas bubbles are released when it is pressed. The muscles at first look like boiled meat. They then become dark with a greenish tint; the tissue is a dirty gray in color. In the edematous (toxic) form, the tissues look like jelly and a bloody-serous fluid exudes from the wound. There is little gas in the tissues.
Mixed and other atypical forms of gas gangrene occur. In these forms, the patient’s general condition deteriorates rapidly, and signs of poisoning by the metabolic products of the microbes and decomposition of dead tissues intensify. The temperature rises to 39-40° C, the pulse accelerates (130-150 beats a minute), blood pressure is low (80 mm mercury and lower), and breathing becomes rapid. General excitation or inhibition and insomnia develop. The patient is usually conscious. Treatment consists of emergency surgery, serotherapy, antibiotics, and blood transfusion. Preventative measures include early treatment of the wound and use of antigangrene serum.
P. B. AVISOV