with gas gangrene include alpha toxin and theta toxin. Clostridium perfringens causes 80–90% of infections and produces both these toxins. Alpha toxin (α-toxin) Clostridium perfingens alpha toxin is widely associated with gas gangrene as it is its main virulence factor whilst invading its host. Alpha toxin is associated with hemolysis, thus restricting blood flow towards the area of infection. As the surrounding circulatory system collapses, neutrophils and monocytes, eosinophils and basophils cannot reach target areas of infection. The hemolytic activity of alpha toxin produces an anaerobic environment essential for the proliferation of the bacteria. Alpha toxin also exhibits the ability to infiltrate surrounding cellular tissue and cause a cascade of aberrant biochemical activity. Theta toxin (Θ-toxin) Theta toxin is also employed by Clostridium perfingens as a virulence factor. Theta toxin also promotes vascular degradation as does its counterpart alpha toxin. A platelet-activation factor is employed which triggers an acute inflammatory response in nearby tissues. This inflammatory response leads to constriction of surrounding arteries and promotes an anaerobic environment for Clostridium perfingens growth and pathophysiology. Beta toxin (β-toxin) Beta toxin is an integral virulence factor in promoting enterocolitis and enterotoxemia. This toxin uses pores in the cellular biolipid membrane to import a pathogenic factor into organisms. Pathophysiology Gas gangrene is caused by exotoxin-producing Clostridium species (most often C. perfringens, and C. novyi, but less commonly C. septicum or C. ramnosum), which are mostly found in soil, but also found as normal gut flora, and other anaerobes (e.g., Bacteroides and anaerobic streptococci). Bacterium of the Clostridial species produce two toxins: alpha and theta toxins, which cause necrotizing damage to tissues. Other organisms may occasionally cause gas gangrene (for example, Klebsiella pneumoniae in the context of diabetes). A gas composition of 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen, and 16.1% oxygen was reported in one clinical case. Myonecrosis differs slightly from other types of necrosis. While the underlying causes are almost identical, the type of affected tissue (in particular, muscle tissue) is significantly more important for the patient's general health. Superficial necrosis is unsightly and can lead to unattractive scarring, but otherwise does not affect the patient's likelihood of survival or physical capability to the same extent. However, massive myonecrosis will likely result in the loss of movement of the entire region. If the necrotic damage is allowed to continue throughout an affected limb, then often that entire limb is lost permanently. It