Gangrene
                                ========

þ Dry Gangrene = Simple Necrosis

þ Wet Gangrene
 - Gas Gangrene: when there is gas in the tissues.
 - Clostridial Myonecrosis: involves muscle
 - Necrotizing Fasciitis: no muscle involvement
  + difficult to diagnose on initial visit, about 50% miss rate
  + bandemia may be sensitive but not specific (anecdotal, ERMI)
 - Treatment of choice includes high doses of IV penicillin.
 - Clostridial alpha toxin causes massive local tissue destruction.
 - HBO is effective in dogs with clostridial infections:
   [Demello FJ, Haglin JJ, Hitchcock CR. Comparative study of experimental
   Clostridium perfringens infection in dogs treated with antibiotics, surgery
   and hyperbaric oxygen. Surgery 1973;73:946-41.]
 - HBO may be effective in necrotizing fasciitis.
   [Tibbles PM, Edelsberg JS. Medical progress: Hyperbaric-oxygen therapy.
   NEJM 1996;334(25):1642-8.]
 - recent study (2009 note) recommends non-con CT rather than 
   contrast CT, MRI, X-ray: faster.