Meleneys Ulcer

Description: American College of Hyperbaric Medicine Preferred Protocols The term “Meleney’s ulcer” describes a distinct pathological entity also called progressive bacterial synergistic gangrene. When Meleney described the condition, he had no access to sophisticated culture techniques necessary to isolate fastidious anaerobic bacteria that cause the condition. However, he observed that these wounds, described exclusively in post-operative abdominal incisions, included a mixture of organisms. From his culture results, he deduced that the margin of the ulcer was advanced by the synergistic effect of two organisms growing in a hypoxic environment. Those organisms were a micro-aerophilic, non-hemolytic Streptococcus, and a hemolytic Staphylococcus aureus. Also, the wound could be colonized by other organisms, such as Amoeba and Proteus. Subsequent literature has suggested that cutaneous Amebiasis may be the correct diagnosis of Meleney’s synergistic gangrene (Davison, 1988), or Entamoeba histolytica. The abdominal wall ulcerations originally described by Meleney expanded slowly, spreading by 1 to 2 cm per day. Histology revealed microvascular thrombosis in the dermis followed by liquefaction. The overlying epidermis became devascularized and necrotic. The macroscopic picture is of a full skin thickness ulcer with a rolled necrotic margin, bounded by a zone of painful erythema, denoting the subepidermal spread of the infection.