[Gas gangrene: a military disease?]

Gas gangrene is a general toxi-infection, which is mostly the result of a contamination of the muscles from traumatic or post-operative origin. Muscular necrosis expands very quickly, causes mutilations, hits several organs and leads to shock. The spontaneous evolution is mostly mortal within a couple of hours. For a long time it was considered to be a typical military disease: during World War I some 100,000 German soldiers lost their lives as a direct result. It represented then 10 to 12% of all deads of wounds. This mortality rate decreased between 0.3 and 1.5% during World War II and to 0.016% during the Vietnam WAr. Although gas gangrene is no longer a typical military disease, the holy principles of war surgery must be respected. All war wounds, and in particular those caused by high velocity missiles are contaminated, a.o. by clostridium spores. An immediate suture of those wounds, through which necrotized tissue is covered (an ideal anaerobic environment), furthers the development of gas gangrene. The only prevention consists of debriding those wounds, leaving them opened, followed by a delayed primary suture between the 4th and 7th day after the debridement. Not properly treated will gas gangrene always be mortal. In some instances, an emergency amputation will be the only way to save the patient's life. Antibiotherapy, hyperbaric oxygenotherapy and most of all surgery from the medical triade which is imperative to treat this disease. Thanks to these measures, the mortality rate decreased from 70% before 1960 to 41%. Nonetheless the most important act remains the early, complete, rational and rigorous debridement of the wounds. Far from being an obsolete attitude, this is one of humility, wisdom ... and with future prospects.