Original communication| Volume 5, ISSUE 6, P894-910, June 1939

Download started.


Phagedenic ulcer A report of three gases

      This paper is only available as a PDF. To read, Please Download here.


      The three cases confirm the general experience of others in regard to the treatment of these ulcers. Ordinary methods of treatment are usually of no avail and although these lesions, while under treatment, may tend to regress in one area while progressing in another or even regress and remain dormant for a time, they eventually will progress until they destroy the patient unless something radical is done. Before Meleney introduced the zinc peroxide treatment, there were only three or four cases reported in the literature that had recovered without radical excision of the ulcers,
      In our three cases zinc peroxide alone was powerless to control the lesion, but, when used in conjunction with surgery, it seemed to be of definite benefit, It was never able to stop undermining of skin, ribs, or muscles alone but once these infected areas were completely removed, the material appeared to prevent recurrence, We have no proof of its mode of action and are unable to decide whether it acts specifically against anaerobic organisms by liberating oxygen, as Meleney believes ,30 or whether it merely provides a comfortable nonadherent dressing which promotes drainage and requires such meticulous care of the wound that healing results.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alexander E.G.
        Postoperative Spreading Superficial Gangrene.
        Ann, Surg. 1926; 84: 461-463
        • Baker W.H.
        • Terry C.C.
        Case of Postoperative Progressive Gangrene of the Skin.
        J. A. M. A. 1932; 98: 138-139
        • Ballin M.
        • Morse P.F.
        Progressive Postoperative Gangrene of Skin.
        Am. J. Surg. 1931; 11: 81-87
        • Bartlett Agnes V.
        Studies on Phagedenic Ulcers.
        in: A Thesis Presented to the Faculty of the Yale University School of Medicine for the Degree of Doctor of Medicine. 1938
        • Borelli C.
        Diffuse Superficial Gangrene of Abdominal Wall After Laparotomy.
        Gior. ital. d. mal. ven. 1924; 65: 326-338
        • Brewer G.E.
        • Meleney F.L.
        Progressive Gangrenous Infection of Skin and Subcutaneous Tissues Following Operation for Acute Perforative Appendicitis.
        Study in Symbiosis, Tr. Am. S. A. 1926; 44: 389-410
        • Brewer G.E.
        • Meleney F.L.
        Ann, Surg. 1926; 84: 438-450
        • Brunsting L.A.
        • Goeckerman W.H.
        • O'Leary P.A.
        Pyoderma (Echthyma) Gangrenosum; Clinical and Experimental Observations in 5 Cases Occurring in Adults.
        Arch. Dermat. & Syph. 1930; 22: 655-680
        • Carol W.L.L.
        Spreading Gangrenous Ulceration of Abdominal Wall After Operation (Appendectomy).
        Nederl. tijdschr. v. geneesk. 1932; 76: 1836-1843
        • Christopher F.
        Severe Spreading Carbuncular Infection of the Chest Wall Following Rib Resection Under Local Anesthesia.
        S. Clin. North America. 1924; 4: 795-810
        • Cole W.H.
        • Heideman M.L.
        Amebic Ulcer of the Abdominal Wall Following Appendectomy With Drainage. Report of a Case.
        J. A. M. A. 1929; 92: 537-540
        • Cullen T.S.
        Progressively Enlarging Ulcer of Abdominal Wall Involving Skin and Fat, Following Drainage of an Abdominal Abscess Apparently of Appendiceal Origin.
        Surg., Gynec. & Obst. 1924; 38: 579-582
        • Freeman L.
        Progressive Gangrenous Painful Ulcerations of the Abdominal Skin and Subcutaneous Tissues Following Operation.
        Ann. Surg. 1930; 92: 779-785
        • Gillespie M.G.
        Phagedenic Ulceration of Skin.
        Ann. Surg. 1928; 88: 248-251
        • Gordon F.N.
        Progressive Gangrenous Ulceration of the Abdominal Wall.
        U. S. Vet. Bur. M. Bull. 1928; 4: 1045-1047
        • Hellstrom J.
        Zur Kenntnis den postoperativen Bauchwandnekrosen nach Laparotomien.
        Acta. chir. Scandinav. 1930; 66: 184-796
        • Hicken N.F.
        Infectious Gangrene of the Skin Due to Bacterial Synergism With Particular Reference to Noma and Postoperative Cutaneous Gangrene.
        Arch. Surg. 1935; 31: 253-265
        • Holman E.
        Phagedenic Ulceration—Its Recognition and Treatment.
        Surg., Gynec. & Obst. 1935; 60: 304-317
        • Horsley J.S.
        Certain Symbiotic Bacterial Infections Producing Gangrene With Special Reference to Principles of Treatment.
        J. A. M. A. 1932; 98: 1425-1429
        • Kappis M.
        Eine eigenartige von Operationaswunden ausgehende, fortschreit-ende Hautnekrose.
        Beitr. z. klin. Chir. 1932; 155: 179-2110
        • Liedberg N.
        Zur Frage der postoperativen fortschreitenden Hautgangrän nach Eingrifen an Bauch und thorax.
        Acta. chir. Scandinav. 1936; 77: 354-377
        • Liedberg N.
        Ein weiterer fall von progrediierender Hautgangrän.
        Acta, chir. Scandinav. 1936; 77: 378-382
        • Luckett W.H.
        Large Phagedenic Ulcer of Abdomen.
        Ann, Surg. 1909; 50: 605-608
        • Lynn F.S.
        Postoperative Gangrenous Ulcer of Abdominal Wall.
        J. A. M. A. 1931; 97: 1597-1602
        • Mayeda T.
        Eine seltsame Hautgeschwürsbildung nach der Appeudektomie.
        Deutsche ztschr. f. Chir. 1926; 199: 350-353
        • Meleney F.L.
        Bacterial Synergism in Disease Processes With Confirmation of Synergistic Bacterial Etiology of Certain Type of Progressive Gangrene of Abdominal Wall.
        Ann. Surg. 1931; 94: 961-981
        • Meleney F.L.
        Differential Diagnosis Between Certain Types of Infectious Gangrene of the Skin.
        Surg., Gynec. & Obst. 1933; 56: 847-867
        • Meleney F.L.
        Zinc Peroxide in the Treatment of Micro-Aerophilic and Anaerobic Infections.
        Ann. Surg. 1935; 101: 997-1011
        • Meleney F.L.
        Zinc Peroxide in Surgical Infections.
        S. Clin. North America. 1936; 16: 691-711
        • Meleney F.L.
        • Johnson B.A.
        Further Laboratory and Clinical Experiences in the Treatment of Chronic Undermining Burrowing Ulcers With Zinc Peroxide.
        Surgery. 1937; 1: 169-221
        • Meleney F.L.
        • Johnson B.A.
        Prophylactic and Active Treatment of Surgical Infections With Zinc Peroxide.
        Surg., Gynec. & Obst. 1937; 64: 387-392
        • Patterson H.A.
        Progressive Postoperative Cutaneous Gangrene.
        Ann. Surg. 1932; 96: 1091-1097
        • Poate H.R.G.
        Spreading Gangrenous Inflammation.
        M. J. Australia. 1930; 2: 398-399
        • Probstein J.G.
        • Seelig M.G.
        The Treatment of Postoperative Gangrenous Infection of Skin and Subcutaneous Tissue With Blood From Immunized Donors.
        Surg., Gynec. and Obst. 1928; 47: 247-251
        • Scotson F.H.
        Progressive Postoperative Gangrene of Skin.
        Lancet. 1933; 1: 80-82
        • Shipley A.M.
        Progressive Gangrenous Ulceration of Abdominal Wall.
        Ann. Surg. 1928; 87: 245-249
        • Stewart-Wallace A.M.
        Progressive Postoperative Gangrene of Skin.
        Brit. J. Surg. 1935; 22: 642-656