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The Unusual Presence of Gas From a Puncture Wound: A Case Report

Published:March 22, 2018DOI:https://doi.org/10.1053/j.jfas.2017.11.003

      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

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      References

        • Hatheway C.L.
        Toxigenic clostridia.
        Clin Microbiol Rev. 1990; 3: 66-98
        • Brucato M.P.
        • Patel K.
        • Mgbako O.
        Diagnosis of gas gangrene: does a discrepancy exist between the published data and practice.
        J Foot Ankle Surg. 2014; 53: 137-140
        • Anderson C.B.
        • Marr J.J.
        • Jaffe B.M.
        Anaerobic streptococcal infections stimulating gas gangrene.
        Arch Surg. 1972; 104: 186-189
        • Bessman A.N.
        • Wagner W.
        Nonclostridial gas gangrene: report of 48 cases and review of the literature.
        JAMA. 1975; 233: 958-963
        • Goering R.
        • Dockrell H.
        • Zuckerman M.
        • Chiodini P.
        • Roitt I.
        Bacterial infections of skin, soft tissue, and muscle.
        in: Mims' Medical Microbiology. ed 5. Elsevier Health Sciences, New York2013: 337-343
        • Mader J.T.
        • Calhoun J.
        Bone, joint, and necrotizing soft tissue infections.
        in: Baron S. Medical Microbiology. ed 4. University of Texas Medical Branch at Galveston, Galveston, TX1996
        • Wolff K.
        • Goldsmith L.
        • Katz S.
        • Gilchrest B.
        • Paller A.
        • Leffell D.
        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
        • Tan J.H.
        • Koh B.T.H.
        • Hong C.C.
        • Lim S.H.
        • Liang S.
        • Chan G.W.H.
        • Wang W.
        • Nather A.
        A comparison of necrotising fasciitis in diabetics and non-diabetics.
        Bone Joint J. 2016; 98-B: 1563-1568
        • Bennett J.
        • Dolin R.
        • Blaser M.
        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
        • Michalska M.
        • Wolf P.
        Pseudomonas exotoxin A: optimized by evolution for effective killing.
        Front Microbiol. 2015; 6: 963
        • Fisher J.R.
        • Conway M.J.
        • Takeshita R.T.
        • Sandoval M.R.
        Necrotizing fasciitis: importance of roentgenographic studies for soft-tissue gas.
        JAMA. 1979; 241: 803-806
        • Yang Z.
        • Hu J.
        • Qu Y.
        • Sun F.
        • Leng X.
        • Li H.
        • Zhan S.
        Interventions for treating gas gangrene.
        Cochrane Database Syst Rev. 2015; (CD010577)
        • Goh T.
        • Goh L.G.
        • Ang C.H.
        • Wong C.H.
        Early diagnosis of necrotizing fasciitis.
        Br J Surg. 2014; 101: e119-e125
        • Finegold S.M.
        Host factors predisposing to anaerobic infections.
        FEMS Immunol Med Microbiol. 1993; 6: 159-163
        • Bussewitz B.
        • Littrell S.
        • Fulkert K.
        • VanCourt R.
        High-pressure water injection of the foot with associated subcutaneous emphysema: a case report.
        J Foot Ankle Surg. 2010; 49: 399.e15-399.e20
        • Afshar A.
        Pressurized air injection causing subcutaneous emphysema in a pediatric population.
        J Foot Ankle Surg. 2008; 47: 66-68
        • Panchbhavi V.K.
        • Hecox S.E.
        All that is gas is not gas gangrene: mechanical spread of gas in the soft tissues.
        J Bone Joint Surg. 2006; 886: 1345-1346
        • Friedman R.J.
        • Gumley G.J.
        Crepitation simulating gas gangrene.
        J Bone Joint Surg. 1985; 674: 646-647
        • Burnham J.
        • Kirby J.
        • Kollef M.
        Diagnosis and management of skin and soft tissue infections in the intensive care unit: a review.
        Intensive Care Med. 2016; 42: 1899-1911
        • Khalil T.
        • Newman R.J.
        Gas in the soft tissues following a penetrating wound-gangrene or not gangrene?.
        Injury. 1994; 25: 337-338