Progressive Postoperative Gangrene of the Skin

Dodd, Harold; Heekes, John W.; Geiser, Hans

doi:10.1001/archsurg.1941.01210120021003

Cited by 8 publications

(1 citation statement)

References 16 publications

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“…The last group appears well beyond the peaks of the curves for the other two and gives basis for the inference that the development of postoperative gangrenous ulcération in the wound depends on factors other than those related to the appendicitis itself. expansion of similar summaries presented by Stewart-Wallace andHolman in 1935 andDodd, Heekes andGeiser in 1941 (table).…”

Section: Clinical Observationsmentioning

confidence: 88%

Progressive Gangrene in an Operative Wound

Leonard¹

1944

Arch Surg

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Section: Clinical Observationsmentioning

confidence: 88%

Progressive Gangrene in an Operative Wound

Leonard¹

1944

Arch Surg

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Postoperative Bacterial Synergistic Cellulitis of Abdominal Wall

Behrend¹,

Krouse²

1952

JAMA

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In this era of antibiotics and chemotherapeutic agents the incidence of postoperative wound infections has been reduce to a negligible percentage. This is due not only to these new agents but also to improvement in the efficiency of personnel, sterilization of instruments and fields, and improved surgical techniques that follow the basic concepts of good surgery and good tissue care. Against this background, there occur, rarely, certain infectious complications of normal surgical treatment. These complications, at first slow-moving, are insidious, relentless, and almost totally resistant to the usual modes of treatment. All concerned, the surgeon, the physician, the bacteriologist, and the pathologist, may well conclude that much is yet to be done in the field of bacteriology in assessing the specific organism or organisms causing such an infection and in determining the best specific therapy to combat them.All types of chronic gangrene, although characterized by certain differences, are caused by special combinations of organisms. They may be conveniently classified as follows:1 (a) postoperative progressive bacterial synergistic gangrene of the abdominal or chest wall, (b) gangrenous impetigo or ecthyma, (c) fusospirochetal in¬ fection of the skin, and (d) amebic infection of the skin.We are concerned with the first type as it affects the ab¬ dominal wall. This type of infection, due to an unusual synergism, has been described by Meleney,2 Mester,3 Brewer and Meleney,4 Carroll,5 Lichtenstein,6 Dodd,7 and Bassow.8 Vier 9 has pointed out that it may be seen but once or twice in the experience of the average sur¬ geon; he states, "... but when it does occur, it is so devas¬ tating to patient and distressing to surgeon that one is im¬ pressed with the importance of its early diagnosis and treatment." Cultures taken from such a gangrenous area contain microaerophilic nonhemolytic streptococci asso¬ ciated with hemolytic micrococcus pyogenes aureus.The purpose of this paper is to report a case of a post¬ operative progressive inflammation of the anterior ab¬ dominal wall, in many ways similar to and as distressing as the gangrenous form. The infection was manifested grossly as an intense edematous type of cellulitis, with no evidence of gangrene. An anaerobic Streptococcus and a gram-positive hemolytic aerobic Bacillus identified as B. subtilis were isolated from the tissue. Injection of these organisms in combination into animals produced a similar tissue lesion. REPORT OF A CASEA 37-year-old white man was admitted to the Jewish Hos¬ pital Nov. 6, 1945, with the chief complaint of a hernia of 20 years' duration. The patient had first noticed a lump in the right groin. This lump had enlarged progressively over the course of years, and for the last 10 years the patient had been wearing a supportive truss. He had no other complaints refer¬ able to this local area. There were no gastrointestinal, genito¬ urinary, or musculoskeletal symptoms. None of the other systems were contributory to his condition. The patient had b...

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Diagnosis of Meleney's synergistic gangrene

Davson

Jones²,

Turner³

1988

Journal of British Surgery

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A retrospective and comparative study of 127 case reports of Meleney's postoperative progressive synergistic gangrene and of 62 examples of postoperative amoebic skin gangrene, showed that these two entities were clinically indistinguishable and that therefore a purely clinical diagnosis of Meleney's gangrene could not be made. Furthermore, a critical appraisal of the bacteriological data indicated that a certain diagnosis of Meleney's gangrene cannot be provided by the clinical bacteriologist. Finally, the histological features were entirely non-specific thus precluding a definitive diagnosis by the histopathologist. If Meleney's entity cannot be diagnosed its existence becomes debatable. The alternative diagnosis of cutaneous amoebiasis is advanced for consideration. Several of the outstanding features of Meleney's progressive gangrene, hitherto unexplained, are better understood if Entamoeba histolytica is accepted as the prime cause rather than bacteria.

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Progressive Postoperative Gangrene of the Skin

Cited by 8 publications

References 16 publications

Progressive Gangrene in an Operative Wound

Progressive Gangrene in an Operative Wound

Postoperative Bacterial Synergistic Cellulitis of Abdominal Wall

Diagnosis of Meleney's synergistic gangrene

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