HBO Emergencies: Necrotizing Fasciitis/Gas Gangrene, Acute Peripheral Ischemia
Necrotizing Fasciitis. Infections are frequently divided into 1) non-limb and non-life threatening
infection such as cellulites or abscess 2) limb or life threatening infection. The latter includes
necrotizing fasciitis, gas gangrene, and other limb threatening soft tissue necrotizing infections.
Necrotizing fasciitis is divided into Type I, a polymicrobial infection caused by aerobe and anaerobic
bacteria that affects patients with diabetes or other causes of immune suppression and Type 2 which
occurs in patients without comorbid conditions. Type 2 necrotizing infection is usually due to group A
beta hemolytic Streptococcus. Predisposing factors to Type 2 include surgical procedures, decubitus
ulcers, childbirth and parenteral drug use. Hyperbaric (HBO) as adjunctive therapy to antibiotics and
surgery and HBO significantly reduces morbidity and mortality and associated amputations in
necrotizing soft tissue infection. Mortality without HBO is 34% - with HBO 11.9%.
Necrotizing Fasciitis
of the Arm
Gas Gangrene is associated with trauma. The incidence has declined with tetanus immunization but is
still seen and must be quickly recognized. The greatest incidence is in men with an undiagnosed occult
colon cancer. Gangrene is a necrotizing infection secondary to clostridium perfringens which is rapidly
spreading and lethal. The clinical triad of anesthesia, brawny edema and feathery gas in the soft tissues is
highly suggestive of this diagnosis. Diagnosis could not await cultures and is made with a Gram stain of
fluid aspirated by syringe. The hallmark sign is gram-positive rods on Gram stain. This disease is an HBO,
surgical debridement and IV antibiotic condition. HBO haltes the alpha toxin production which perpetuates
the rapid spread and reduces mortality and morbidity.
Acute Peripheral Ischemia is acute arterial vessel interruption with associated ischemia. A myriad
of medical conditions can cause acute peripheral ischemia. It is associated with trauma as well as medical
conditions such as vasculitis and iatrogenic arterial medication injections. Central retinal artery occlusion is
an example.
Gas Gangrene of the
Arm
Acute Peripheral
Ischemia of Fingers
due to Inadvertant
Arterial Injection
HBO Saves Lives and Limbs
Web Site Designed and Created by Robert David Tufft MD
Necrotizing Fasciitis. Infections are frequently divided into 1) non-limb and non-life threatening
infection such as cellulites or abscess 2) limb or life threatening infection. The latter includes
necrotizing fasciitis, gas gangrene, and other limb threatening soft tissue necrotizing infections.
Necrotizing fasciitis is divided into Type I, a polymicrobial infection caused by aerobe and anaerobic
bacteria that affects patients with diabetes or other causes of immune suppression and Type 2 which
occurs in patients without comorbid conditions. Type 2 necrotizing infection is usually due to group A
beta hemolytic Streptococcus. Predisposing factors to Type 2 include surgical procedures, decubitus
ulcers, childbirth and parenteral drug use. Hyperbaric (HBO) as adjunctive therapy to antibiotics and
surgery and HBO significantly reduces morbidity and mortality and associated amputations in
necrotizing soft tissue infection. Mortality without HBO is 34% - with HBO 11.9%.
