Hyperbaric oxygen: value in management of nonhealing saphenectomy wounds.

The greater saphenous vein is commonly used as a conduit for arterial bypass in both cardiac and peripheral vascular operations. Although saphenectomy wound complications occur infrequently, such problems may be quite serious. We report a case in which hyperbaric oxygen therapy was extremely valuable in the management of a very difficult saphenectomy wound.     

Hyperbaric oxygen in the treatment of calciphylaxis: a case series.

BACKGROUND: Calciphylaxis, also referred to as calcific uraemic arteriolopathy, is a syndrome associated with end-stage renal disease (ESRD), and causes necrotic skin ulcers, often leading to a fatal outcome. Hyperbaric oxygen (HBO(2)) therapy has been used to enhance wound healing, but its role in the treatment of calciphylaxis is unclear. METHODS: We undertook a retrospective study of patients on renal replacement therapy with biopsy-proven calciphylaxis who were treated with HBO(2) between March 1997 and February 2000. RESULTS: Five patients were treated with HBO(2): three patients were on continuous ambulatory peritoneal dialysis (CAPD) and two were on chronic haemodialysis therapy. None of the patients had uncontrolled hyperparathyroidism and none underwent parathyroidectomy. The patients each received 25-35 treatments of HBO(2) at 2.5 atmospheres for 90 min per treatment. Two of these patients had complete resolution of extensive necrotic skin ulcers, with no adverse effects of HBO(2) therapy. Both had improvement in wound area transcutaneous oxygen pressure (P(tc)O(2)) with administration of 100% oxygen when measurements were taken at normobaric and hyperbaric pressures. In the other three patients receiving HBO(2), the skin lesions did not resolve. P(tc)O(2) was measured in two of these patients, neither of whom showed improvement with 100% oxygen administered at normobaric pressure. CONCLUSIONS: The data support a role for HBO(2) in the treatment of some patients with calciphylaxis, particularly as in the absence of uncontrolled secondary hyperparathyroidism there are few therapeutic options.     

Effect of autologous fat transfer in acute burn wound management: A randomized controlled study

ObjectiveThe use of fat grafting is being widely used for different indications one of which is wound healing. In this study we compare the use of autologous fat grafting (AFG) as a novel indication in acute burn wounds healing and burn scarring to the conventional methods of burn wound management both clinically and histologically. Several small observational studies demonstrated the effect of the AFG in healing of chronic wounds, different vascular ulcers or effect on scars yet no randomized controlled trial is available to compare its role with conventional methods.MethodsThe study was a prospective, open-label single center, randomized control clinical trial included 100 patients with superficial and deep dermal burns from March 2019 to March 2020 randomized to AFG protocol consisted of a single injection of autologous fat grafting then dressed with nano fat (Group A) or conventional methods of serial dressings with 1% silver sulphadiazine or other topical agents (Group B). Inclusion criteria included newly admitted burn patients with affected total body surface area (TBSA) (10%?25%) while exclusion criteria included burns patients with affected TBSA of< 10% or> 25%, or loss of subcutaneous fat, fascia, muscles and bones, inhalational burn, and burns in genitalia, perineum and peri-anal areas and co-morbidity(ies) that might affect wound healing or eligibility for anaesthesia and surgery. Also, results were confirmed by histological analysis for samples from both groups by light microscopic examination, and the nano-fat was subjected to flow cytometric analysis of the cluster of differentiation (CD) markers of mesenchymal stem cells markers CD 90, CD44, CD45, CD 73, and CD 34. (ClinicalTrials.gov Identifier: NCT03791710)ResultsWe found a significant reduction in total hospital stay days (p = <0.001), less further skin grafting (p = 0.003), less contracture formation (p = <0.002) while scar texture improved (p = <0.001) in group A compared to group B. Flow cytometric analysis documented that the nano-fat was positive to CD 90, 73, 44, 45 and 34.ConclusionIn a comparison between AFG protocol to the conventional methods in the treatment of acute burn wounds, AFG protocol was associated with significant clinical improvement in the form of lower hospital stay time, lower incidence of scaring or contracture and lower skin grafting use which was confirmed by serial photographic and histological assessment.     

Hyperbaric oxygen therapy in acute trauma.

The usefulness of hyperbaric oxygen therapy in the treatment of acute trauma is described. The results in 71 such cases are given.     

Hyperbaric oxygen therapy in adriamycin extravasation: an experimental animal study

Adriamycin extravasation is a serious problem that can lead to severe local necrosis and damage to underlying nerves, tendon, and muscle. There are some experimental studies in which conflicting results were reported about the beneficial effects of hyperbaric oxygen (HBO) in adriamycin-induced skin lesions. In this study the effect of HBO on the healing of adriamycin-induced wounds was investigated in the Wistar-Albino rat model. Ninety-five rats underwent injection of a 0.7-ml adriamycin solution (2 mg per milliliter) subcutaneously on the right upper hind legs. The HBO group (n = 43) received HBO treatment (at 2.5 ATA for 80 minutes) twice a day for 28 days. The control group (n = 42) did not receive any therapy. Lesion size was measured for 4 weeks. There was no significant difference in lesion size between the groups on days 7 (p = 0.1364) and 14 (p = 0.1123), but the lesion size was significantly smaller in the HBO group than in the control group on days 21 (p = 0.0251) and 28 (p = 0.0001). Of 36 animals with lesions in the HBO group, complete wound healing occurred in 16 animals by day 40. However, there was no complete wound healing in any of the 36 animals with lesions in the control group. The beneficial effect of HBO in adriamycin-induced skin lesions was observed in this experimental study.     

Hyperbaric oxygen therapy in the management of severe acute anaemia in a Jehovah's Witness

A case is described in which a Jehovah's Witness patient who refused blood transfusion suffered massive antepartum haemorrhage, her haemoglobin falling as low as 2.0 g.dl(-1). She was treated on an intensive care unit with intermittent positive pressure ventilation and general supportive measures, pulsed hyperbaric oxygen therapy and recombinant human erythropoietin.     

Hyperbaric oxygen and chronic osteomyelitis.

Forty patients with chronic osteomyelitis were treated with hyperbaric oxygen as an adjunct to surgical therapy and antibiotics and followed for an average of 2 years with a recurrence rate of 15%. The mechanism of action of hyperbaric oxygen in osteomyelitis is probably an indirect one of improving local vascularity and potentiating phagocytosis. Many of these patients represent a refractory group with poor prognosis due to the etiology of the infection, site of involvement, and duration of infection prior to treatment. The recurrence rate following this mode of treatment seems to be primarily related to inadequate surgical management. There was no definite correlation between the site of the infection of pathologic organism and recurrence. Although this is a preliminary report, the results are encouraging. Hyperbaric oxygen may be indicated as an adjunct to good surgical and medical management, particularly in patients with refractory chronic osteomyelitis and in whom ablative surgery is under consideration as the only other means of controlling the infection.     

Hyperbaric oxygen in neurosurgery

Background  The therapeutic use of pure oxygen, even under hyperbaric conditions, has been well established for about 50 years, whereas the discovery of oxygen occurred 250 years earlier. Many neurosurgical patients suffer from brain tissue damage, due to reduced blood flow, obstructive vessel disease, or as a result of traumatic brain injury. Methods and results  The application of pure oxygen in these patients is the only method of increasing the O₂ concentration in tissue with impaired blood supply and can minimize secondary impairment of brain tissue. Discussion  In this brief historical overview we focus on the development and evidence of hyperbaric oxygenation in this specific field of insufficient oxygen supply to the central neural tissue. Conclusion  With the use of modern biological methods and new study designs, HBO has a place in evidence-based treatment of patients with neural tissue damage.     

Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis

BACKGROUND: Necrotizing fasciitis (NF) is an uncommon but serious infection of fascia and skin associated with considerable morbidity and mortality. One modality proposed for improving the outcome of this condition is hyperbaric oxygen (HBO) therapy. This is a form of medical treatment that involves intermittent inhalation of 100% oxygen under pressures exceeding the atmosphere. The aim of this article is to review current practice and evidence for the use of HBO as adjunctive therapy in the management of NF. METHODS: A survey of published English literature through searches of Medline and PubMed was carried out using the following key words: "necrotizing fasciitis," "Fournier's gangrene," "necrotizing soft tissue infections," "hyperbaric oxygen therapy," "and hyperbaric oxygen chambers." RESULTS: The results of studies on the use of HBO therapy in NF are inconsistent. Some studies have demonstrated that HBO can improve patient survival and decrease the number of debridements required to achieve wound control, whereas others have failed to show any beneficial effect. CONCLUSIONS: Encouraging results have been achieved with the addition of HBO therapy to standard treatment regimes, thus justifying further research in this field. More robust evidence by way of a prospective randomized trial is necessary before widespread and routine use of HBO in the management of NF can be recommended.     

Hyperbaric oxygen in the treatment of burns.

Since 1972, over 800 burn victims have been treated with hyperbaric oxygen at the Burn Center of Sherman Oaks Community Hospital in Los Angeles. HBO is used only as an adjuvant to standard resuscitation and is not intended to replace current accepted therapy. The results of the first three-year study program show definite changes in burn care delivery. There has been a definite decrease in the mortality as compared with our own predictions and statistics and with those of the N.B.I.E. In addition, a marked improvement in morbidity and a reduction in hospital stay were noted.     

Hyperbaric oxygen in severe burns

A paired control study of the effect of hyperbaric oxygen (HBO) on the treatment of severe burns failed to reveal either a deleterious or salutary effect on mortality. Treatment had a deleterious effect on renal function and resistance to bacterial infection.