Gangrene

Aggressive debridement of devitalised tissue and repair of compromised vascular supply greatly reduce the frequency of gas gangrene in contaminated deep wounds. Intramuscular adrenaline (epinephrine), prolonged application of tourniquets, and surgical closure of traumatic wounds should be avoided. Patients who have open fractures are at particular risk of gas gangrene if the wound is surgically closed. Patients who have contaminated wounds should receive prophylactic antibiotics.[5]Cohen J, Powderly WG, Berkley SF, et al. Cohen and Powderly: infectious diseases. 2nd ed. Philadelphia, PA: Mosby Elsevier; 2004. The UK National Institute for Health and Care Excellence recommends PICO negative pressure wound dressings for closed surgical incisional wounds to decrease surgical site infections and seromas.[38]National Institute for Health and Care Excellence. PICO negative pressure wound dressings for closed surgical incisions. May 2019 [internet publication]. https://www.nice.org.uk/guidance/mtg43 These are not available in the US.

For patients who have evidence of an aggressive localised soft-tissue infection, prompt surgical exploration of that site is of extreme importance to determine whether a necrotising process is present. The same is true for patients who have milder local features associated with severe systemic toxicity.[5]Cohen J, Powderly WG, Berkley SF, et al. Cohen and Powderly: infectious diseases. 2nd ed. Philadelphia, PA: Mosby Elsevier; 2004.

The main modifiable factors in the primary prevention of ischaemic gangrene are avoidance and cessation of smoking, control of lipids and cholesterol, tight glycaemic control in diabetic patients, control of hypertension, regular exercise and avoidance of obesity, and regular medical check-ups, along with timely and appropriate interventions if ischaemia starts to develop.