The procedure includes multiple incisions for drainage, fasciotomy for decompression of fascial compartments, and excision of involved muscle. Such surgery can control localized myositis. If the process is extensive and irreversible changes have occurred in an extremity, amputation becomes necessary. Widespread involvement of the abdomen makes extensive resection extremely difficult but not impossible. Such radical debridement is mutilating and presents problems of fluid loss.
Plastic reconstruction is necessary after such surgery.
Simple drainage, fasciotomy where indicated, and excision of necrotic tissue are usually sufficient for treating clostridial cellulitis. As an adjunct to surgical therapy, antibiotics are employed to eliminate organisms not removed by debridement and to control any bacteremia that may occur. When Gram's stain shows gram-negative bacilli, an aminoglycoside, a newer cephalosporin, or a fluoroquinolone should be added initially. Clindamycin, metronidazole, and chloramphenicol are alternatives for patients who are highly allergic to penicillin. Despite enthusiasm for hyperbaric oxygen therapy, there have been no controlled trials of its use in humans, and its precise role in the management of gas gangrene and other anaerobic infections remains to be defined.