Necrotizing fasciitis

Synergistic gangrene

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Synergistic gangrene

Synergistic gangrene, also known as progressive bacterial gangrene and Meleney’s gangrene, is caused by the synergistic action of two or more organisms, commonly aerobic haemolytic Staphylococcus and microaerophilic non – haemolytic Streptococcus. It is more common in patients with diabetes and is often related to recent trauma or infection. Where it affects the scrotum and perineum, it has been termed Fournier’s gangrene.

Clinical f eatures

There may be no precipitating factor, but most follow infections or recent surgery (previously termed progressive postoperative gangrene). Around the wound an area of cellulitis appears, which spreads rapidly. The area is exquisitely tender, and, as gangrene evolves, it liberates an offensive odour. The patient becomes profoundly septic and unwell.

Treatment

High – dose, broad – spectrum antibiotics should be commenced immediately, but the mainstay of treatment is a radical debridement of all the affected area. Following the initial debridement, the wound should be inspected twice daily at least for evidence of spread, and further debridement performed until all the affected area is cleared.

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