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Casimiro R, Poleri F, Pinto J, Andresen C, Costa H, Zenha H. Hyperbaric Oxygen Therapy in Upper Limb Crush Injury: Why and When? Cureus 2024; 16:e59146. [PMID: 38803792 PMCID: PMC11129722 DOI: 10.7759/cureus.59146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction In 2016, the European Committee for Hyperbaric Medicine strongly recommended hyperbaric oxygen therapy (HBOT) adjunctive to surgery in post-traumatic crush injuries, initiating as rapidly as possible. For the last 30 years, HBOT has been used in crush injury, but in most cases as a last resort, after skin flaps necrosis or wound bed infection, diminishing its potential benefits as a complementary treatment. It is, therefore, essential to understand how HBOT modulates the outcome of crush injury, and when to use it, since this can be a significant and underused therapeutic weapon that may alter the natural course of these patients. Methods Nineteen (n=19) adult patients with upper limb crush injuries underwent adjunctive HBOT, after the initial surgical approach. The measured outcomes included trauma-related acute complications (tissue necrosis and local infection), and late complications (pseudarthrosis and late deep infection). Results Only six (n=6) patients started HBOT in the first 24 hours. Four (n=4) patients presented acute complications; in half of those cases (n=2), HBOT was initiated more than 24 hours post-injury. Late complications were observed in three patients, none of which had initiated HBOT in the first 24 hours post-injury. Conclusions Either lack of awareness or logistic difficulties, preclude initiating timely HBOT, limiting its potential benefits. It is important to alert all practitioners to the right timing to initiate HBOT in order to improve these patients' outcomes.
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Affiliation(s)
- Rui Casimiro
- Plastic and Reconstructive Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Filipa Poleri
- Plastic and Reconstructive Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Jorge Pinto
- Plastic and Reconstructive Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Carolina Andresen
- Plastic and Reconstructive Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Horacio Costa
- Plastic and Reconstructive Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Horacio Zenha
- Plastic and Reconstructive Surgery, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Chang DH, Hsieh CY, Chang CW, Wang HH, Chang HT. The use of hyperbaric oxygen therapy in the treatment of hand crush injuries. Wound Repair Regen 2024; 32:146-154. [PMID: 38129180 DOI: 10.1111/wrr.13134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/11/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
Hyperbaric oxygen therapy (HBOT) has been used as an adjuvant treatment for crush injury because it can improve tissue hypoxia and stimulate wound healing. However, the actual role of HBOT in crush hand injury is still unknown. This study is to assess the efficacy of HBOT for crush hand patients, as well as the impact of HBOT initiation timing. Between 2018 and 2021, 72 patients with crush hand injury were retrospectively reviewed. The patients were divided into the HBOT and control group, and each group had 36 patients. The average session of HBOT was 18.2 (5-32 sessions) per patient, and no patient had a complication related to the treatment. The two groups had similar demographics, but HBOT group had larger injured area (73.6 ± 51.0 vs. 48.2 ± 45.5 cm2 , p = 0.03). To better control the confounding factors, we performed the subgroup analysis with cut-off injured area of 50 cm2 . In the patients with smaller injured area (≦50 cm2 ), the HBOT group had shorter wound healing time (29.9 ± 12.9 vs. 41.0 ± 18.9 days, p = 0.03). The early HBOT group (first session ≤72 h post-operatively) had shorter hospital stay (8.1 ± 6.4 vs. 15.5 ± 11.4 days, p = 0.04), faster wound healing (28.7 ± 17.8 vs. 41.1 ± 18.1 days, p = 0.08) and less operations (1.54 ± 0.78 vs. 2.41 ± 1.62, p = 0.06) although the latter two didn't achieve statistical significance. HBOT is safe and effective in improving wound healing of hand crush injury. Early intervention of HBOT may be more beneficial. Future research is required to provide more evidence.
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Affiliation(s)
- Dun-Hao Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan
| | - Chi-Ying Hsieh
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Che-Wei Chang
- Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsu-Hui Wang
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Chest Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hou-Tai Chang
- Center of Hyperbaric Oxygen, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan, Taiwan
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Raj M, Bhartiya RK, Rajput AK, Singh SK, Jadon JPS, Gill SPS. Hyperbaric Oxygen Therapy for Soft Tissue Injury in Open Musculoskeletal Trauma: A Prospective Study. Cureus 2023; 15:e48848. [PMID: 38106741 PMCID: PMC10723627 DOI: 10.7759/cureus.48848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background Non-union, chronic pain, functional disability, and infection are all things that have been associated with open fractures with severe soft tissue damage leading to the need for additional hospitalization, and sometimes even subsequent surgeries and weeks or months of rehabilitation. Open fractures and severe musculoskeletal injuries are occasionally treated with hyperbaric oxygen therapy (HBOT) in an effort to reduce the risk of complications and increase the likelihood of a successful recovery. Methods A prospective randomized controlled study was done between January 2019 and August 2022 at a tertiary health care center including 60 patients with a severe soft tissue injury (Grade II and III) divided into two groups - group-CT (30 patients who received conventional treatment) and group HT (30 patients, who received HBOT in addition to conventional treatment). The outcome was measured according to the Bates-Jensen Wound Assessment Tool. Results The wound size, depth, and granulation were significantly reduced in group-HT patients. In the final session, the patient's severity of the wound in group-HT was significantly reduced (P = 0.0001) compared to group-CT. Conclusions Patients who received HBOT reported a significant improvement in their wounds.
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Affiliation(s)
- Manish Raj
- Orthopedics, AIIMS Deoghar, Deoghar, IND
| | - Raj K Bhartiya
- Orthopedics and Traumatology, Maa Vindhyawasini Autonomous State Medical College, Mirzapur, IND
| | - Ajay K Rajput
- Orthopedics, Uttar Pradesh University of Medical Sciences, Etawah, IND
| | - Santosh Kumar Singh
- Orthopedics and Traumatology, Maa Vindhyawasini Autonomous State Medical College, Mirzapur, IND
| | | | - S P S Gill
- Orthopedics, Uttar Pradesh University of Medical Sciences, Etawah, IND
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Tuluy Y, Aksoy A, Sir E. Effects of external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation. Diving Hyperb Med 2023; 53:2-6. [PMID: 36966516 PMCID: PMC10318177 DOI: 10.28920/dhm53.1.2-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/08/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Tamai zone 1 replantation poses a challenge due to the very small size of the vascular structures; often there is no vein for anastomosis. Replantation may have to be done with only an arterial anastomosis. In our study, we aimed to evaluate the success of replantation by combining external bleeding and hyperbaric oxygen treatment (HBOT) in Tamai zone 1 replantation. METHODS Between January 2017 and October 2021, 17 finger replantation patients who underwent artery-only anastomosis due to Tamai zone 1 amputation received 20 sessions of HBOT with external bleeding after the 24th postoperative hour. Finger viability was assessed at the end of treatment. A retrospective review of outcomes was performed. RESULTS Seventeen clean-cut finger amputation patients were operated on under digital block anaesthesia with a finger tourniquet. No blood transfusion was required. In one patient, complete necrosis developed and stump closure was performed. Partial necrosis was observed in three patients and healed secondarily. Replantation in the remaining patients was successful. CONCLUSIONS Vein anastomosis is not always possible in fingertip replantation. In Tamai zone 1 replantation with arteryonly anastomosis, post-operative HBOT with induced external bleeding appeared to shortened the hospital stay and was associated with a high proportion of successful outcomes.
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Affiliation(s)
- Yavuz Tuluy
- Department of Plastic Reconstructive and Aesthetic Surgery, Turgutlu State Hospital, Manisa, Turkey
- Corresponding author: Dr Yavuz Tuluy, Plastic, Reconstructive and Aesthetic Surgery, Manisa Turgutlu State Hospital, Turgutlu, Manisa, 45000, Turkey
| | - Alper Aksoy
- Konur Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Bursa, Turkey
| | - Emin Sir
- İzmir Kavram Vocational School, Department of Plastic Reconstructive and Aesthetic Surgery, İzmir, Turkey
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Rech FV, Simões RS, Pires JA, Florêncio-Silva R, Fagundes DJ. Effect of hyperbaric oxygenation on random rat skin flaps vascularization. Acta Cir Bras 2021; 36:e360906. [PMID: 34755766 PMCID: PMC8580510 DOI: 10.1590/acb360906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/21/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose: To evaluate the effect of hyperbaric oxygenation (HBO) on angiogenesis in
random rat skin flaps, by immunoexpression of vascular endothelial growth
factor A (VEGF-A). Methods: Forty adult rats were divided into four groups: GE) epilated; GE/HBO)
epilated subjected to HBO; GER) epilated submitted to dorsal skin flap;
GER/HBO) epilated subjected to dorsal skin flap + HBO. HBO was performed
with rats inside a chamber under atmosphere close to 100% oxygen and
pressure of 2.4 absolute atmospheres, 2h per day during seven consecutive
days. GE and GER groups were placed in the hyperbaric chamber without HBO.
Then, under anesthesia, skin flaps were removed and separated into three
portions relative to pedicle fixation. The samples were fixed in formalin
and processed for paraffin embedding. Histological sections were submitted
to immunohistochemistry for VEGF-A detection. The number of
immunostained-blood vessels were counted under light microscopy. Results: GE and GE/HBO groups showed normal and similar skin morphology in the three
flap portions. A fibrin-leukocyte crust, along with denatured collagen and
intense leukocyte infiltrate, was mainly observed in the dermis of the
medial and distal flap portions of GER group. Meanwhile, the GER/HBO group
presented more regions with intact collagen and small areas of leukocyte
infiltrate in the three flap regions. VEGF-A-immunostained blood vessels
were largely seen in all regions of GE and GE/HBO groups, whereas no
significant differences were found between these groups. A decrease in
vascularization was noticed in GER and GER/HBO groups, which was more
evident in the most distal portion of the flaps. However, the number of
VEGF-A-immunostained blood vessels in GER/HBO group was significantly higher
when compared to GER group. Conclusions: Hyperbaric oxygenation was associated with increased angiogenesis and
improved viability of rat skin flaps.
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Abstract
Coverage of soft tissue defects in the upper extremity caused by infection and debridement of infected tissue is a challenging problem. Treatment starts with prompt identification and eradication of infection, including antibiotics and extensive debridement. Optimizing the patient's medical and nutritional status can facilitate eradication of infection and wound healing. Coverage of soft tissue defects caused by infection and debridement demands consideration of many factors. Options include healing by primary or secondary intention, skin grafts, local flaps, and distant flaps. Negative pressure wound therapy and acellular dermal matrices can also aid in coverage.
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Affiliation(s)
- Vanessa Prokuski
- Philadelphia Hand to Shoulder Center/Jefferson, Philadelphia, PA, USA; Orthopedic Care Physicians Network, 675 Paramount Drive, Suite 205, Raynham, MA 02767, USA
| | - Adam Strohl
- Plastic and Reconstructive Surgery, Philadelphia Hand to Shoulder Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite G-114, Philadelphia, PA 19107, USA.
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Howell RS, Criscitelli T, Woods JS, Gillette BM, Brem H, Gorenstein S. A Perioperative Approach to Increase Limb Salvage When Treating Foot Ulcers in Patients With Diabetes. AORN J 2018; 107:431-440. [PMID: 29595900 DOI: 10.1002/aorn.12099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Foot ulceration in patients with diabetes increases the risk of lower extremity amputation. Major amputations produce substantial adverse consequences, increase length of hospital stay, diminish quality of life, and increase mortality. In this article, we describe approaches that decrease amputations and improve the quality of life for patients with diabetes and foot ulcers. We highlight the role of the perioperative nurse, who is essential to providing optimal patient care in the perioperative period. Perioperative care of patients with diabetes involves providing optimal surveillance for a break in the skin of the foot, screening for neuropathy, following guidelines for foot ulcer infections, preparing for pathophysiology-based debridement, using adjuvant therapies, and offloading the patient's affected foot. Nurses should understand the disease process and pathophysiology and how to use these approaches in the perioperative setting to assist in curtailing the morbidity and mortality associated with foot ulcers in patients with diabetes.
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