Slark Hyperbaric Unit
Waitematā District Health Board
PO Box 32051
Devonport
Auckland 0744
New Zealand
www.healthpoint.co.nz
Slark Hyperbaric Unit | Waitematā | Te Whatu Ora
Postal Address
Contact Details
Emergency Referrals:
Diving Emergency Service (DES) 24 hours a day, 7 days a week:
Ph 0800 4 DES 111 (0800 4 337 111) or if outside New Zealand: Ph 64 9 3746758
Elective (non-emergency) Referrals:
Inpatients: SMO please complete e-referral in Clinical Portal. If you wish to discuss appropriateness of referral, please contact Clinical Director, Dr Chris Sames on 021 1255687.
Other patients: Medical staff please click on the following link to open the referral form and complete all details and email it to Dr Chris Sames at chris.sames@waitematadhb.govt.nz
Tours and Technical Information:
Phone: (09) 4872213
Or contact online here
Dive Medicals:
Occupational & Recreational: Dr Chris Sames
Contact online here
Diver Alert Network:
Oxygen Provider Training: Basil Murphy
Contact online here
Clostridial Myositis & Myonecrosis (Gas Gangrene)
Clostridial myositis and myonecrosis is an acute, rapidly progressive infection of the soft tissues commonly known as “gas gangrene.” The infection is caused by one of several bacteria in the group known as “clostridium.” While over 150 species of clostridium have been identified, only a few commonly cause gas gangrene.
The infection typically spreads from a discrete focus of clostridium within the body. The original source can actually be within the body, as clostridium normally live in the gastrointestinal tract. Alternatively, the infection can originate outside the body, such as when infection results from contamination of wounds during trauma (e.g. motor vehicle accidents). Gas gangrene infection is severe and can advance quickly. Besides replicating and migrating, the organisms which cause gas gangrene produce poisons known as exotoxins. Exotoxins are capable of liquefying adjacent tissue and inhibiting local defence mechanisms which might normally contain a less virulent infection. As such, the advancing infection of gas gangrene may simply destroy healthy tissue in its path and spread over the course of hours.
Clostridium bacteria are “anaerobic,” meaning that they prefer low oxygen concentrations to grow. If clostridia are exposed to high amounts of oxygen, their replication, migration, and exotoxin production can be inhibited. This is the rationale for the use of hyperbaric oxygen in the treatment of gas gangrene.
Repeated treatment in the hyperbaric chamber has the potential to slow the progress of the infection while the two primary therapies, antibiotics and surgical resection of infected tissue, control it. The advantages of hyperbaric oxygen treatment in gas gangrene are two-fold. First, it may be lifesaving because exotoxin production is rapidly halted and less heroic surgery may be needed in gravely ill patients. Second, it may be limb and tissue-saving, possibly preventing limb amputation that might otherwise be necessary.
References
1. Bakker DJ. Clostridial myonecrosis. In Davis JC, Hunt TK, eds. Problem Wounds: The Role of Oxygen. New York: Elsevier, 1988:153-172.
2. Hirn M. Hyperbaric oxygen in the treatment of gas gangrene and perineal necrotizing fasciitis: A clinical and experimental study. Eur J Surg 1993;570 (Suppl):9-36.
3. Hyperbaric Oxygen Therapy Committee. Clostridial myositis and myonecrosis (gas gangrene). In: Hampson NB, ed. Hyperbaric Oxygen Therapy: 1999 Committee Report. Kensington, MD: Undersea and Hyperbaric Medical Society, 1999:13-16.
4. Stevens DL, Bryant AE, Adams K, Mader JT. Evaluation of therapy with hyperbaric oxygen for experimental infection with Clostridium perfringens. Clin Infect Dis 1993;17:231-237.
https://healthpoint.co.nz/public/respiratory/slark-hyperbaric-unit-waitemata-te-whatu/