Abstract
The presence of gas within soft tissues as suggested by plain film radiographs and
magnetic resonance imaging is usually sufficient evidence for a gas-producing bacterial
infection. A thorough clinical examination and history and tissue culture are necessary
to better determine the source of the gas. However, despite the unremarkable physical
examination findings, the present case of a plantar puncture wound rapidly developed
gas in the tissues and warranted surgical exploration and repair. Delaying treatment
in any case of potential gas gangrene can be limb- and life-threatening. Only later
was it revealed by the patient's husband that the wound might have been contaminated
soon after the injury from a source other than the puncture, which led to the early
presentation of gas on the imaging studies.
Level of Clinical Evidence
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal of Foot and Ankle SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Toxigenic clostridia.Clin Microbiol Rev. 1990; 3: 66-98
- Diagnosis of gas gangrene: does a discrepancy exist between the published data and practice.J Foot Ankle Surg. 2014; 53: 137-140
- Anaerobic streptococcal infections stimulating gas gangrene.Arch Surg. 1972; 104: 186-189
- Nonclostridial gas gangrene: report of 48 cases and review of the literature.JAMA. 1975; 233: 958-963
- Bacterial infections of skin, soft tissue, and muscle.in: Mims' Medical Microbiology. ed 5. Elsevier Health Sciences, New York2013: 337-343
- Bone, joint, and necrotizing soft tissue infections.in: Baron S. Medical Microbiology. ed 4. University of Texas Medical Branch at Galveston, Galveston, TX1996
- Soft-tissue infections: erysipelas, cellulitis, gangrenous cellulitis, and myonecrosis.in: Fitzpatrick's Dermatology in General Medicine Online. ed 7. McGraw-Hill, New York2008: 1720-1731
- A comparison of necrotising fasciitis in diabetics and non-diabetics.Bone Joint J. 2016; 98-B: 1563-1568
- Skin and soft tissue infections.in: Mandell G.L. Bennett J.E. Doun R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. Elsevier/Saunders, Philadelphia2015: 1194-1226
- Pseudomonas exotoxin A: optimized by evolution for effective killing.Front Microbiol. 2015; 6: 963
- Necrotizing fasciitis: importance of roentgenographic studies for soft-tissue gas.JAMA. 1979; 241: 803-806
- Interventions for treating gas gangrene.Cochrane Database Syst Rev. 2015; (CD010577)
- Early diagnosis of necrotizing fasciitis.Br J Surg. 2014; 101: e119-e125
- Host factors predisposing to anaerobic infections.FEMS Immunol Med Microbiol. 1993; 6: 159-163
- High-pressure water injection of the foot with associated subcutaneous emphysema: a case report.J Foot Ankle Surg. 2010; 49: 399.e15-399.e20
- Pressurized air injection causing subcutaneous emphysema in a pediatric population.J Foot Ankle Surg. 2008; 47: 66-68
- All that is gas is not gas gangrene: mechanical spread of gas in the soft tissues.J Bone Joint Surg. 2006; 886: 1345-1346
- Crepitation simulating gas gangrene.J Bone Joint Surg. 1985; 674: 646-647
- Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review.Intensive Care Med. 2016; 42: 1899-1911
- Gas in the soft tissues following a penetrating wound-gangrene or not gangrene?.Injury. 1994; 25: 337-338
Article info
Publication history
Published online: March 22, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
