Gas gangrene in traumatic hand injuries. Report of three cases

Gaseous gangrene is an infection with anaerobies germs characterized by gaseous infiltration of soft tissues with quick and serious damage to the general state. Known in war time, it rages also in civilian practice. Two etiologies are dominating: post-trauma gaseous gangrenes, post-surgery gaseous gangrenes. Among post-trauma gaseous gangrenes, the ones on departure of inferior members are the most frequent arising from fractures or from luxations open or closed. Localisation on superior limbs is scarce, specially after soft parts' trauma. We report three cases of superior limbs' gaseous gangrene after seemingly benign trauma. Diagnosis has been set by the clinical surgery, and the presence of gas bubbles at soft tissues' radiography. It didn't exist any favorising agent such as diabetes, arterial insufficiency, intercurrent disease treated with corticoïdes or with immuno-depressors. Bacteriological levyings have not put the causal germ in evidence, this is due to levying conditions. Evolution of gaseous gangrene depends on quickness of diagnosis and treatment. This one includes surgical flattening, discharge's incisions and excisions of devitalized tissues, as well as antibiotherapy with 20 000 to 60 000 U penicilline by parenteral way. We didn't need appeal to hyperbare oxygenotherapy. Simple procedures of secondary repair surgery were sufficient to restoration of a normal function. Gaseous gangrene is a real surgical urgency, even without bacteriological proof.