TACKLING CLOSTRIDIAL MYONECROSIS WITHOUT ANTITOXIN drshubham12597@gmail.com

 

TACKLING CLOSTRIDIAL MYONECROSIS WITHOUT ANTITOXIN

1

 

 

 

 

India

Oral or Poster

Gas gangrene, or clostridial myonecrosis, is a rapidly progressing and potentially fatal soft tissue infection caused primarily by Clostridium perfringens. Standard management includes prompt surgical debridement, broad-spectrum antibiotics, and anti-tetanus gas gangrene serum (ATGGS). However, with improved surgical practices and antibiotic regimens, the necessity of antitoxin therapy remains debatable.

A 60-year-old blind male presented with swelling, pain, and discharging sinus in the left lower limb five days after trauma. Clinical examination revealed crepitus up to the knee. Radiographs confirmed extensive subcutaneous gas. An emergency below-knee amputation (BKA) was performed. Due to proximal progression, an above-knee amputation (AKA) was required on postoperative day 10. Wound management included daily dressing with EUSOL and hydrogen peroxide. Piperacillin-tazobactam was administered; no antitoxin serum or hyperbaric oxygen therapy was used.

Tissue cultures confirmed Clostridium species. Post-AKA wound care led to healthy granulation. The wound was closed on postoperative day 30, and the patient was discharged in stable condition on day 40 with no systemic complications.

This case demonstrates that gas gangrene can be successfully managed without antitoxin serum when timely surgical intervention, broad-spectrum antibiotics, and meticulous wound care are applied. In resource-limited settings, modern management protocols can achieve favorable outcomes, challenging the conventional reliance on antitoxin therapy.