BACKGROUND: Gas gangrene is a rapidly progressive and severe disease that results from bacterial infection, usually as the result of an injury; it has a high incidence of amputation and a poor prognosis. It requires early diagnosis and comprehensive treatments, which may involve immediate wound debridement, antibiotic treatment, hyperbaric oxygen therapy, Chinese herbal medicine, systemic support, and other interventions. The efficacy and safety of many of the available therapies have not been confirmed. OBJECTIVES: To evaluate the efficacy and safety of potential interventions in the treatment of gas gangrene compared with alternative interventions or no interventions. SEARCH METHODS: In March 2015 we searched: The Cochrane Wounds Group Specialized Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Science Citation Index, the China Biological Medicine Database (CBM-disc), the China National Knowledge Infrastructure (CNKI), and the Chinese scientific periodical database of VIP INFORMATION (VIP) for relevant trials. We also searched reference lists of all identified trials and relevant reviews and four trials registries for eligible research. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We selected randomized controlled trials (RCTs) and quasi-RCTs that compared one treatment for gas gangrene with another treatment, or with no treatment. DATA COLLECTION AND ANALYSIS: Independently, two review authors selected potentially eligible studies by reviewing their titles, abstracts and full-texts. The two review authors extracted data using a pre-designed extraction form and assessed the risk of bias of each included study. Any disagreement in this process was solved by the third reviewer via consensus. We could not perform a meta-analysis due to the small number of studies included in the review and the substantial clinical heterogeneity between them, so we produced a narrative review instead. MAIN RESULTS: We included two RCTs with a total of 90 participants. Both RCTs assessed the effect of interventions on the 'cure rate' of gas gangrene; 'cure rate' was defined differently in each study, and differently to the way we defined it in this review.One trial compared the addition of Chinese herbs to standard treatment (debridement and antibiotic treatment; 26 participants) against standard treatment alone (20 participants). At the end of the trial the estimated risk ratio (RR) of 3.08 (95% confidence intervals (CI) 1.00 to 9.46) favoured Chinese herbs. The other trial compared standard treatment (debridement and antibiotic treatment) plus topical hyperbaric oxygen therapy (HBOT; 21 participants) with standard treatment plus systemic HBOT (23 participants). There was no evidence of difference between the two groups; RR of 1.10 (95% CI 0.25 to 4.84). For both comparisons the GRADE assessment was very low quality evidence due to risk of bias and imprecision so further trials are needed to confirm these results.Neither trial reported on this review's primary outcomes of quality of life, and amputation and death due to gas gangrene, or on adverse events. Trials that addressed other therapies such as immediate debridement, antibiotic treatment, systemic support, and other possible treatments were not available. AUTHORS' CONCLUSIONS: Re-analysis of the cure rate based on the definition used in our review did not show beneficial effects of additional use of Chinese herbs or topical HBOT on treating gas gangrene. The absence of robust evidence meant we could not determine which interventions are safe and effective for treating gas gangrene. Further rigorous RCTs with appropriate randomisation, allocation concealment and blinding, which focus on cornerstone treatments and the most important clinical outcomes, are required to provide useful evidence in this area.

Dopamine is a catecholamine used in the treatment of circulatory shock of various etiologies. The usual dose range used is from 1 to 25 ug/kg/min. When used at higher doses, the prominent effect of dopamine on the vasculature is vasoconstriction induced by stimulation of alpha-adrenergic receptors. We report a case of dopamine gangrene. The gangrene developed on the injection site in the right dorsum of foot in a 43-year-old man during infusion of dopamine for treatment of septic shock. The gangrenous lesion healded after change of injection site to subclavian vein. The dosage of dopamine was not higher, we think that the gangrene developed due to the local vasoconstriction caused by dopamine leakage from the vessels.

Dopamine, a sympathomimetic agent, is one of the drugs used to improve cardiac output and blood pressure in advanced cardiac life-support in the context of conditions such as shock and heart failure. It is available only for intravenous use. We report a case of dopamine gangrene which has never been reported in Korean medical literature. Four gangrenous lesions developed in both forearms and the left leg of a 72-year-old man during a 7-day infusion of dopamine 3 microgram per kg per minute as treatment for septic shock, which corresponded to the injection sites. The gangrenous lesions healed up spontaneously leaving scars after administration of dopamine was discontinued.

El objetivo fue describir producciones brasileñas publicadas en los últimos veinte años acerca de la gangrena de Fournier.Revisión integradora realizada en las bases de datos LILACS, MEDLINE, BDENF y Colecciona SUS, con el descriptor “Gangrenade Fournier”. Se seleccionaron textos publicados entre enero de 1994 y julio de 2014, en portugués y disponiblesgratuitamente en Internet. Según los 14 artículos encontrados, los principales síntomas de la gangrena de Fournier incluyenmalestar, con sensaciones dolorosas, fiebre alta, edema, malestar general, sudoración. En la mayor parte de los casos, sonobservados eritema y formación de bollas, surgiéndose una herida. El cuadro clínico ayuda en la selección de la terapia antimicrobianaempírica antes del resultado de la cultura. En conclusión, el diagnóstico precoz y el tratamiento apropiado yagresivo son cruciales en el pronóstico del paciente. Aún, hay escasez de producciones científicas brasileñas con gran poderde evidencia sobre el tema.

A 17-year-old boy presented with Fournier gangrene associated with previously undiagnosed Crohn ileocolitis. Fournier gangrene was managed by débridement, broad-spectrum antibiotics, and hyperbaric oxygen. A diverting ileostomy was performed before skin grafting and scrotal reconstruction. Microscopy of a full-layer surgical sample from the terminal ileum revealed granulomas with multinucleated histiocytes, consistent with Crohn disease. Crohn disease was treated with mesalamine, metronidazole, 6-mercaptopurine, and infliximab. The patient was discharged on hospital day 32. At 6-month follow-up, reconstruction of his scrotum had completely healed. Ostomy output was normal.

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BACKGROUND: Reconstruction of scrotal defects after Fournier gangrene is often achieved with skin grafts or flaps, but there is no general consensus on the best method of reconstruction or how to approach the exposed testicle. We systematically reviewed the literature addressing methods of reconstruction of Fournier defects after debridement. METHODS: PubMed and Cochrane databases were searched from 1950 to 2013. Inclusion criteria were reconstruction for Fournier defects, patients 18 to 90 years old, and reconstructive complication rates reported as whole numbers or percentages. Exclusion criteria were studies focused on methods of debridement or other phases of care rather than reconstruction, studies with fewer than 5 male patients with Fournier defects, literature reviews, and articles not in English. RESULTS: The initial search yielded 982 studies, which was refined to 16 studies with a total pool of 425 patients. There were 25 (5.9%) patients with defects that healed by secondary intention, 44 (10.4%) with delayed primary closure, 36 (8.5%) with implantation of the testicle in a medial thigh pocket, 6 (1.4%) with loose wound approximation, 96 (22.6%) with skin grafts, 68 (16.0%) with scrotal advancement flaps, 128 (30.1%) with flaps, and 22 (5.2%) with flaps or skin grafts in combination with tissue adhesives. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. CONCLUSIONS: Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. There is no conclusive evidence to support flap coverage of exposed testes rather than skin graft. A reconstructive algorithm is proposed. Skin grafting or flap reconstruction is recommended for defects larger than 50% of the scrotum or extending beyond the scrotum, whereas scrotal advancement flap reconstruction or healing by secondary intention is best for defects confined to less than 50% of the scrotum that cannot be closed primarily without tension.

Resumen Los defectos de la inmunidad constituyen un importante factor predisponente a las infecciones agresivas de alto riesgo de mortalidad. Se presenta el caso de un adolescente con antecedente de inmunodeficiencia, quien de forma rápida desarrolla infección del tipo gangrena gaseosa. La infección inicia en miembro inferior izquierdo y en menos de 24 horas desarrolla compromiso sistémico con falla orgánica múltiple y el paciente fallece. Se revisan los aspectos fisiopatológicos y las características del agente causal, resaltando la importancia del diagnóstico y tratamiento oportuno y temprano.

Vasopressin (Pitressin) infusion through peripheral veins is a commonly used modality for control of bleeding esophageal varices. In this report we describe the development of infected gangrene at the site of accidental vasopressin infiltration in a patient with diabetes mellitus, cirrhosis and bleeding esophageal varices. Among the explanations for the development of gangrene are: 1. continuous intravenous administration; 2. diabetic peripheral vascular disease; 3. mechanical compression of extravasated fluid in a closed space. No antagonist has been clinically proven to reverse the vasoconstrictive effects of vasopressin.

BACKGROUND:Fournier's gangrene is a difficult infective condition to treat. We report our experience of the management of this disease with honey dressings. MATERIAL AND METHODS:Thirty patients admitted with the diagnosis of Fournier's gangrene were randomly allocated to two groups, one group treated by honey dressing and the other by Eusol dressing. All patients were treated with broad-spectrum antibiotics and underwent debridement and delayed closure as required. RESULTS:In 14 patients treated with honey dressing, healthy granulation appeared in 4 patients in one week and in all patients within 3 weeks. One patient died. In 16 patients treated with Eusol dressing, healthy granulation appeared in one week and by 4 weeks in remaining patients. Two patients died. Secondary suturing and skin grafting was required in 9 patients in each group. Mean hospital stay was 28 days (range 9-40 days) in the honey-treated group and 32 days (range12-52 days) in the Eusol-treated group. CONCLUSION:In this study, honey was found to be beneficial in the treatment of Fournier's gangrene.