The activation of platelets and Hageman Factor also leads to activation of inflammatory cascades. Leukotrienes are released while the presence of gammaglobulin on the bubble skin, combined with the products of complement activation, attract white blood cells to the area 66. Leukocytes may interact directly with the bubble or with damaged endothelium. The relevance of inflammation in DI underlies the recommended use of anti-inflammatory agents and, more recently, of lidocaine 67. Lidocaine also has leukocyte anti-adherent properties 68,69.
Rare indisputable cases have been observed after uncomplicated tooth removals49 conventional surgery50 and after sub-cutaneous or intramuscular injections - mostly of corticosteroids or non steroidal antiinflammatory drugs. Septic injections carried out by IV drug abusers are a frequent point of entry51 here the bacteria are quite specific and include several germs of the oral flora such as Prevotella)52.
Etiology can also be of medical origin by contamination of cutaneous ulcers20,22. Diabetic foot lesions currently make up nearly 40 of the lesions present when gas gangrene develops. Iatrogenic causes such as intramuscular or intra-articular injections are less frequent causes - mostly involving injections of corticosteroids or non steroidal anti-inflammatory drugs24-25. Contamination can also be surgical - particularly after amputations in vascular surgery or in diabetic patients. There have been rare cases occurring after aseptic procedures such as hip surgery26.
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