Bacterial synergistic gangrene: causes, symptoms, diagnosis, and treatment

Bacterial synergistic gangrene, also known as postoperative progressive synergetic gangrene, Meleney synergetic gangrene, or chronic undermining burrowing ulcers, is a subcutaneous tissue infection, also invades the subcutaneous fascia.


Causes

The pathogens are mainly small aerobic streptococcus and staphylococcus aureus. In addition, Proteus, Enterobacter, pseudomonas, and clostridium can be cultured in the lesion.


Signs and Symptoms

Bacterial synergistic gangrene often occurs in the incision of thoracic surgery, abdominal surgery, abdominal abscess, or thoracic drainage, and sometimes can occur around the colostomy or ileostomy site or other trauma. Subjective pain and tenderness in the lesion is present, mostly 2 weeks after surgery or injury. A purplish red nodule, surrounded by red halos, occurs initially, developing into pale purplish red necrosis surrounded by purplish red halos surrounded by bright red halos. Inner margin of necrosis is undermining when the skin lesion expands. Central granulation of the skin lesion expands continuously. The depth of skin lesion is often limited to upper 1/3 of the subcutaneous fat, rarely into the sarcolemma. Satellite lesions can occur through sinus tracts in adipose tissue. Systemic mild fever, anemia, and malnutrition are often present.


Diagnosis

According to a history of surgery or trauma, typical halos, it can be diagnosed.


Treatment

Extensive excision of necrotic tissue in ulcers and peripheral lesions is necessary. Skin grafting may be appropriate in recovery stage.

Effective antibiotics can be selected based on the results of bacterial culture and drug susceptibility test.

Zinc oxide paste can be used to protect healthy skin around the lesion.