Clostridial
gas gangrene and perineal
necrotizing fasciitis or
Fournier's gangrene are rare but serious
infections with an acute onset, rapid progression, systemic
toxemia and a high mortality rate. The aim of this study was to investigate the efficacy of surgery,
antibiotic treatment,
surgical intensive care and in particular the role of hyperbaric
oxygen (HBO) in the management of these
infections. An experimental rat model was used to investigate the possibilities for measuring tissue
oxygen and
carbon dioxide tensions during hyperbaric
oxygen treatment. In addition to this preliminary experimental study,
Silastic tube tonometer and capillary sampling techniques were tested to measure the effect of hyperbaric
oxygen treatment on subcutaneous
oxygen and
carbon dioxide tensions in patients with
necrotizing fasciitis and healthy controls. Between January 1971 and April 1997, 53 patients with Clostridial
gas gangrene were treated in the Department of Surgery, University of Turku. The patients underwent surgical
debridement, broad spectrum
antibiotic therapy and a series of hyperbaric
oxygen treatments at 2.5 atmospheres absolute pressure (ATA). Twelve patients died (22.6%).
Hyperbaric oxygen therapy in
gas gangrene seems to be life-, limb- and tissue saving. Early diagnosis remains essential. Patient survival can be improved if the disease is recognized early and appropriate
therapy instituted promptly. Between February 1971 and September 1996, 33 patients with perineal
necrotizing fasciitis were treated in the Department of Surgery, University of Turku. The management included surgical
debridement of the necrotic tissue with incisions and drainage of the involved areas,
antibiotic therapy, hyperbaric oxygen treatment at 2.5 ATA pressure and
surgical intensive care. Three patients died giving a mortality rate of 9.1%. The survivors received
hyperbaric oxygen therapy for 2-12 times. Our results indicate that
hyperbaric oxygenation is an important therapeutic adjunct in the treatment of
Fournier's gangrene. Electrical equipment should not be used unsheltered in a hyperbaric chamber due to the increased risk of fire. The subcutaneous tissue gas tensions of rats were therefore measured using a subcutaneously implanted
Silastic tube tonometer and a capillary sampling technique. The method was successfully adapted to hyperbaric conditions. The subcutaneous
oxygen tension levels increased five fold and the
carbon dioxide tension levels two fold compared to initial levels. The PO2 and PCO2 of subcutaneous tissue and arterial blood were measured directly in six patients with
necrotizing fasciitis and three healthy volunteers in normobaric conditions and during hyperbaric
oxygen exposure at 2.5 ATA pressure. The measurements were carried out in healthy tissue and at the same time in the vicinity of the infected area of the patients. During HBO at 2.5 ATA subcutaneous
oxygen tensions increased several fold from baseline values and
carbon dioxide tensions also increased, but to a lesser degree in both healthy and infected tissues. When examining the subcutaneous PO2 levels measured from patients with
necrotizing fasciitis, the PO2 was regularly higher in the vicinity of the infected area than in healthy tissue. In general, HBO treatment resulted in a marked increase in tissue oxygenation in both healthy tissue and in the vicinity of infected tissue. The hyper-oxygenated tissue zone surrounding the infected area may be of significance in preventing the extension of invading microorganisms.