Notes on the diagnosis and treatment of gas gangrene : with a suggested scheme for the bacteriological investigation of war wounds / War Wounds Committee and Committee of London Sector Pathologists.

Date:
1940
Catalogue details

Licence: Public Domain Mark

Credit: Notes on the diagnosis and treatment of gas gangrene : with a suggested scheme for the bacteriological investigation of war wounds / War Wounds Committee and Committee of London Sector Pathologists. Source: Wellcome Collection.

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    4 from some blanching around the wound from pressure. As the swelling increase skin becomes ‘‘ dirty brown ”’ in colour, with marbling of the surface from stasis the subcutaneous veins. Mottled purple patches then make their appearance and finally greenish yellow areas, in which blebs may form. * In retroperitoneal infections a peculiar bronzing of the skin overlying the infected area has been described : this may be transient or may go on to extensive destructi of the skin. It may be due in part to disruption of the venules and arterioles running ~ through the loose areolar tissue beneath the skin. -s At operation certain muscle changes may be observed* :—(1) the normal] the muscle, the fibres of which stand out more prominently and are friable; (2) the brick red colour changes to olive green, the muscle is much more friable and tends — to break up on handling; (3) the muscle becomes greenish-black, is glistening and softens to a pultaceous mass. be In flat superficial muscles, such as the sartorius and biceps humeri, the change ~ between normal muscle and infected brick red, non-contractile muscle, can be very clearly seen. The line of demarcation is lighter in colour and a ridge may be palpable © between healthy and infected tissue. This ridge is due to the initial swelling of the ~ muscle fibres in the early stages of infection. 2: In some cases gas bubbles may be seen in X-ray films taken before operation, — and this finding may sometimes be of value in recognising the presence of an anaerobic — infection. It should be noted, however, that gas may be shown apart from the state. 5. (c) Surgical Prophylaxis and Treatment, with Special Reference to Wound-Excision of the tissues bounding and bordering upon the track of the missile almost inevitably occurs after a lapse of time which varies from four or five hours to eighteen hours according to the nature and virulence of the micro-organisms, the amount of damage to the tissues, the loss of blood and the degree of shock and fatigue, all of which contribute to diminish the resistance of the individual to infection. It necessarily follows that excision of the contaminated wound should be practised at the earliest opportunity, before actual infection of the tissues has had time to supervene. _ “ Through-and-through ” wounds, on the other hand, can often be left alone; this applies especially to those which are produced by bullets, and in which there is no evidence of constitutional disturbance. The apertures of entry and exit are often small in such cases; but, even where there is an explosive wound of exit, drainage is free, and excision is usually unnecessary. In the case of injured men who come under observation only at a later period, when organisms have already reached the living tissues bordering onthe cavity of the wound, or when the wound is passing through a “ stage of physiological reaction to injury,” the chief aim of the surgeon is to provide adequate drainage by appropriate incisions; the time for prophylactic excision has now passed. In those late cases, however, in which there is any suspicion of gangrenous infection of muscle, the wound must be widely opened up, and the muscle or group of muscles : | Other circumstances may even dictate the desirability of amputation as the sole surgical measure capable of saving life. * This description of the appearance of the wound, of the muscle changes and the phenomena associated with gas production, applies in the main to Cl. welchii infections and to mixed infections to which Cl. welchit or Cl. septique are contributing. It may be quite inapplicable to the rarer types of gangrene due to Cl. oedematiens or Cl. septique, where the predominant features may be extensive toxic oedema, with absence of gas, and only an extreme hyperaemia of muscle with no necrotic change. :