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Kwee E, Borgdorff M, Schepers T, Halm JA, Winters HAH, Weenink RP, Ridderikhof ML, Giannakópoulos GF. Adjunctive hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries: a systematic review. Eur J Trauma Emerg Surg 2024; 50:1093-1100. [PMID: 38386077 PMCID: PMC11249575 DOI: 10.1007/s00068-023-02426-2] [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: 09/30/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE Traumatic crush injuries of the lower limb often accompany severe complications. The incorporation of hyperbaric oxygen therapy to standard trauma care may have the potential to diminish injury-related complications and improve outcome in such cases. This systematic review aims to evaluate the effectiveness of hyperbaric oxygen therapy in the management of severe lower limb soft tissue injuries. METHODS The electronic databases Medline, Embase and Cochrane Library were searched to identify studies involving patients with crush-associated sever lower limb soft tissue injuries who received hyperbaric oxygen therapy in conjunction with standard trauma care. Relevant data on type of injury, hyperbaric oxygen therapy protocol and outcome related to wound healing were extracted. RESULTS In total seven studies met the inclusion criteria, involving 229 patients. The studies included two randomized clinical trials, one retrospective cohort study, three case series and one case report. The randomized placebo-controlled clinical trial showed a significant increase in wound healing and decrease in the need for additional surgical interventions in the patient group receiving hyperbaric oxygen therapy when compared to those undergoing sham therapy. The randomized non-placebo-controlled clinical trial revealed that early hyperbaric oxygen therapy reduces tissue necrosis and the likelihood of long-term complications. The retrospective cohort study indicated that hyperbaric oxygen therapy effectively reduces infection rates and the need for additional surgical interventions. The case series and case report presented beneficial results with regard to wound healing when hyperbaric oxygen therapy was added to the treatment regimen. CONCLUSION Hyperbaric oxygen therapy is generally considered a safe therapeutic intervention and seems to have a beneficial effect on wound healing in severe lower limb soft tissue injuries when implemented as an addition to standard trauma care.
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Affiliation(s)
- Esmee Kwee
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Marieke Borgdorff
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim Schepers
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jens A Halm
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive Surgery and Handsurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Robert P Weenink
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Department of Hyperbaric Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Emergency Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Georgios F Giannakópoulos
- Trauma Unit, Department of Surgery, Amsterdam UMC (Location AMC), J1A-214 Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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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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Sethuraman KN, Smolin R, Henry S. Is There a Place for Hyperbaric Oxygen Therapy? Adv Surg 2022; 56:169-204. [PMID: 36096567 DOI: 10.1016/j.yasu.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Hyperbaric oxygen therapy (HBOT) involves treating patients by providing 100% oxygen through inhalation while inside a treatment pressurized chamber. The oxygen acts as a drug and the hyperbaric chamber as the dosing device. The effect of hyperbaric hyperoxia is dose dependent and, therefore, treatment depth and duration are important when considering its use. HBOT can either be the primary method of treatment or used adjunctively to medications or surgical techniques. The underpinning physiology is to bring oxygen-rich plasma to hypoxic tissue, preventing reperfusion injury, strengthening immune responsiveness, and encouraging new collagen deposition as well as endothelial cell formation.
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Affiliation(s)
- Kinjal N Sethuraman
- University of Maryland Medical Center, Hyperbaric and Dive Medicine, 22 South Greene Street, Baltimore, MD 2120, USA
| | - Ryan Smolin
- University of Maryland School of Medicine, 685 West Baltimore Street, Suite 150, Baltimore, MD 21201, USA
| | - Sharon Henry
- University of Maryland Medical Center, R A Cowley Shock Trauma Center, Room T1R59, 22 South Greene Street, Baltimore, MD 21201, USA.
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Indications for Emergent Hyperbaric Oxygen Therapy. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2022. [DOI: 10.1007/s40138-022-00251-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Anderson CA, Hare MA, Perdrizet GA. Wound Healing Devices Brief Vignettes. Adv Wound Care (New Rochelle) 2016; 5:185-190. [PMID: 27076996 DOI: 10.1089/wound.2015.0651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Significance: The demand for wound care therapies is increasing. New wound care products and devices are marketed at a dizzying rate. Practitioners must make informed decisions about the use of medical devices for wound healing therapy. This paper provides updated evidence and recommendations based on a review of recent publications. Recent Advances: The published literature on the use of medical devices for wound healing continues to support the use of hyperbaric oxygen therapy, negative pressure wound therapy, and most recently electrical stimulation. Critical Issue: To inform wound healing practitioners of the evidence for or against the use of medical devices for wound healing. This information will aid the practitioner in deciding which technology should be accepted or rejected for clinical use. Future Directions: To produce high quality, randomized controlled trials or acquire outcome-based registry databases to further test and improve the knowledge base as it relates to the use of medical devices in wound care.
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Affiliation(s)
- Caesar A. Anderson
- Department of Emergency Medicine, Centers for Wound Healing and Hyperbaric Medicine, University of California, San Diego, San Diego, California
| | - Marc A. Hare
- Department of Emergency Medicine, Centers for Wound Healing and Hyperbaric Medicine, University of California, San Diego, San Diego, California
| | - George A. Perdrizet
- Department of Emergency Medicine, Centers for Wound Healing and Hyperbaric Medicine, University of California, San Diego, San Diego, California
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Millar IL, McGinnes RA, Williamson O, Lind F, Jansson KÅ, Hajek M, Smart D, Fernandes T, Miller R, Myles P, Cameron P. Hyperbaric Oxygen in Lower Limb Trauma (HOLLT); protocol for a randomised controlled trial. BMJ Open 2015; 5:e008381. [PMID: 26068515 PMCID: PMC4466757 DOI: 10.1136/bmjopen-2015-008381] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Open fractures with significant soft tissue injury are associated with high rates of complications, such as non-union, infection, chronic pain and disability. Complications often require further inpatient care, and in many cases, multiple operations and prolonged rehabilitation. Use of hyperbaric oxygen therapy as an adjunct to standard orthopaedic trauma care has the potential to reduce the complications of musculoskeletal injury and thus improve outcomes. Two previous randomised trials have suggested some positive effect, but neither functional measures nor long-term outcomes were reported. METHODS AND ANALYSIS An international, multicentre, randomised, open-label, clinical trial. Patients with trauma with an acute open fracture of the tibia with severe soft tissue injury (Gustilo grade 3) and high risk of injury-related complications were recruited from participating major trauma hospitals with hyperbaric facilities. Patients were enrolled with the expectation of commencing 12 sessions of hyperbaric oxygen therapy within 48 h of injury. The primary outcome measure is the incidence of acute complications of the open fracture wound at 14 days. Other short-term outcome measures include amputation, need for fasciotomy, time until wound closure, breakdown of closed wounds, time until definitive orthopaedic fixation, number of operative procedures, intensive care stay and hospital stay. Long-term follow-up will continue for 2 years postinjury. ETHICS AND DISSEMINATION Ethics approval was given by The Alfred Health Human Ethics Committee (206/04) and the Monash University Human Research Ethics Committee (CF07/4208). Approval was also obtained from the institutional research ethics committee at each participating site. This study will make a significant contribution to the trauma literature and should answer the question of whether hyperbaric oxygen therapy can significantly improve outcomes in severe lower limb trauma. Collective study results will be published in international journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER Clinicaltrials.gov: NCT00264511; Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12607000559415.
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Affiliation(s)
- Ian L Millar
- Hyperbaric Service, Department of Intensive Care & Hyperbaric Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosemary A McGinnes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Owen Williamson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Folke Lind
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Karl-Åke Jansson
- Department of Molecular Medicine and Surgery, Karolinska Institutet at Karolinska University Hospital, Stockholm, Sweden
| | - Michal Hajek
- Ostrava City Hospital, Ostrava, Czech Republic
- University of Ostrava, Ostrava-Zabreh, Czech Republic
| | - David Smart
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Tiago Fernandes
- Hospital Pedro Hispano, Rua Dr. Eduardo Torres, Matosinhos, Portugal
| | - Russell Miller
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Paul Myles
- Department of Anaesthesia and Perioperative Medicine, The Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Abstract
Hyperbaric oxygen therapy has been approved for primary or adjunctive care in 14 indications. A hyperbaric environment exists when a patient's whole body is physically exposed to 100% oxygen and pressure that is greater than one atmosphere absolute. Hyperbaric oxygen therapy works through the ideal gas laws and is effective as an adjunctive therapy in the treatment of crush injuries. Oxygen is considered a drug and can have contraindications and adverse effects. Hyperbaric therapy works through several different mechanisms in the crush injury. Effects of hyperoxygenation, reduction of edema, infection control enhancement, blood vessel and collagen formation, and reduction of free radicals and reperfusion injury help in healing in patient with crush injuries.
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Murad MH, Altayar O, Bennett M, Wei JC, Claus PL, Asi N, Prokop LJ, Montori VM, Guyatt GH. Using GRADE for evaluating the quality of evidence in hyperbaric oxygen therapy clarifies evidence limitations. J Clin Epidemiol 2013; 67:65-72. [PMID: 24189086 DOI: 10.1016/j.jclinepi.2013.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/26/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The current evidence rating for hyperbaric oxygen therapy indications uses the American Heart Association system, which mainly depends on the study design. STUDY DESIGN AND SETTING We systematically reviewed the literature and applied the Grading of Evidence, Assessment, Development and Evaluation (GRADE) approach to the main patient-important outcomes in each indication. RESULTS We included 17 systematic reviews that synthesized 44 randomized trials and 131 observational studies enrolling 8,145 participants. The quality of evidence for seven indications with category A was high (1), moderate (2), low (2), and very low (2); for 10 indications with category B, it was moderate (1), low (5), and very low (4); and for 1 indication with category C, it was high. The quality of evidence was rated down for the risk of bias and imprecision for most indications and rated up because of large effect size for some indications. Most discrepant ratings were in the indications of decompression illness (C, high), carbon monoxide poisoning (A, very low), and later presentations of idiopathic sudden hearing loss (A, very low). CONCLUSION The GRADE approach uncovered factors affecting the quality of evidence that were otherwise implicit. Knowing these factors can influence clinicians' confidence in applying hyperbaric oxygen therapy and orient the research agenda.
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Affiliation(s)
- Mohammad Hassan Murad
- Division of Preventive, Occupational and Aerospace Medicine, Mayo Clinic, 200 1st Street, Rochester, MN 55902, USA; Knowledge and Evaluation Research Unit, Mayo Clinic, 200 1st Street, Rochester, MN 55902, USA.
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Baynosa RC, Naig AL, Murphy PS, Fang XH, Stephenson LL, Khiabani KT, Wang WZ, Zamboni WA. The effect of hyperbaric oxygen on nitric oxide synthase activity and expression in ischemia-reperfusion injury. J Surg Res 2013; 183:355-61. [PMID: 23485074 DOI: 10.1016/j.jss.2013.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 12/20/2012] [Accepted: 01/03/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Hyperbaric oxygen (HBO) mitigates ischemia-reperfusion (IR) injury via a nitric oxide mechanism that is nitric oxide synthase (NOS) dependent. The purpose of this study was to investigate this NOS-dependent mechanism by examining isoform-specific, tissue-specific, and time-specific upregulation of NOS mRNA, protein, and enzymatic activity. METHODS We raised a gracilis flap in Wistar rats that were separated into early and late phases. Treatment groups included nonischemic control, IR, HBO-treated ischemia-reperfusion (IR-HBO), and nonischemic HBO control. We harvested tissue-specific samples from gracilis, rectus femoris, aorta, and pulmonary tissues and processed them by reverse transcription polymerase chain reaction and Western blot to determine upregulation of isoform-specific NOS mRNA and protein. We also harvested tissue for NOS activity to investigate upregulation of enzymatic activity. Data are presented as mean ± standard error of the mean with statistics performed by analysis of variance. P ≤ 0.05 was considered significant. RESULTS There was no increase in NOS mRNA in the early phase. In the late phase, there was a significant increase in endothelial-derived NOS (eNOS) mRNA in IR-HBO compared with IR in gracilis muscle (79.4 ± 22.3 versus 36.1 ± 4.5; P < 0.05) and pulmonary tissues (91.0 ± 31.2 versus 30.2 ± 3.1; P < 0.01). There was a significant increase in the late-phase eNOS pulmonary protein IR-HBO group compared with IR (235.5 ± 46.8 versus 125.2 ± 14.7; P < 0.05). Early-phase NOS activity was significantly increased in IR-HBO compared with IR in pulmonary tissue only (0.049 ± 0.009 versus 0.023 ± 0.003; P < 0.05). CONCLUSIONS The NOS-dependent effects of HBO on IR injury may result from a systemic effect involving an early increase in eNOS enzymatic activity followed by a late-phase increase in eNOS protein expression within the pulmonary tissues.
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Affiliation(s)
- Richard C Baynosa
- Division of Plastic Surgery, Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada 89102, USA.
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Wolfson N. Amputations in natural disasters and mass casualties: staged approach. INTERNATIONAL ORTHOPAEDICS 2012; 36:1983-8. [PMID: 22714553 DOI: 10.1007/s00264-012-1573-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/02/2012] [Indexed: 11/28/2022]
Abstract
Amputation is a commonly performed procedure during natural disasters and mass casualties related to industrial accidents and military conflicts where large civilian populations are subjected to severe musculoskeletal trauma. Crush injuries and crush syndrome, an often-overwhelming number of casualties, delayed presentations, regional cultural and other factors, all can mandate a surgical approach to amputation that is different than that typically used under non-disaster conditions. The following article will review the subject of amputation during natural disasters and mass casualties with emphasis on a staged approach to minimise post-surgical complications, especially infection.
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Affiliation(s)
- Nikolaj Wolfson
- Department of Orthopaedic Surgery, California Pacific Medical Center, 45 Castro Street, Suite 337, San Francisco, CA 94114, USA.
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Jagodzinski NA, Weerasinghe C, Porter K. Crush injuries and crush syndrome - a review. Part 2: the local injury. TRAUMA-ENGLAND 2010. [DOI: 10.1177/1460408610372441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Crush injuries can occur in considerable numbers following natural disasters or acts of war and terrorism. They can also occur sporadically after industrial accidents or following periods of unconsciousness from drug intoxication, anaesthesia, trauma or cerebral events. A common pathophysiological pathway has been elucidated over the last century describing traumatic rhabdomyolysis leading to myoglobinuric acute renal failure and a systemic ‘crush syndrome’ affecting many organ systems. If left unrecognised or untreated then mortality rates are high. If treatment is commenced early and the systemic effects are minimised then patients are often faced with significant morbidity from the crushed limbs themselves. We have performed a thorough review of the English language literature from 1940—2009 investigating crush injuries and crush syndrome and present a comprehensive, two-part summary. Part 1: The systemic injury, we concentrate on the systemic crush syndrome. We determine the pathophysiology, clinical and prognostic indicators and treatment options such as forced alkaline diuresis, mannitol therapy, dialysis and haemofiltration. We discuss more controversial treatment options such as allopurinol, potassium binders, calcium therapy and other diuretics. We also discuss the specific management issues of the secondary ‘renal disaster’ that can occur following earthquakes and other mass disasters. Part 2: The local injury, we look in more detail at the pathophysiology of skeletal muscle damage following crush injuries and discuss how to minimise morbidity by salvaging limb function. In particular we discuss the controversies surrounding fasciotomy of crushed limbs and compare surgical management with conservative techniques such as mannitol therapy, hyperbaric oxygen therapy, topical negative pressure therapy and a novel topical treatment called gastric pentadecapeptide BPC 157.
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Affiliation(s)
| | | | - Keith Porter
- Selly Oak Hospital, Raddlebarn Road, Birmingham, B29 6JD, UK
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McMillan G, Glover M. The clinical and economic potential of hyperbaric oxygen therapy in the treatment of diabetic ulceration and other conditions. INT J LOW EXTR WOUND 2007; 6:130-8. [PMID: 17909170 DOI: 10.1177/1534734607304626] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Selective use of systemic hyperbaric oxygen therapy (HBOT) is a treatment that deserves further study and analysis. The current situation in the United Kingdom (UK) is discussed in relation to available evidence and practices elsewhere. It would appear that there is increasing evidence that HBOT could benefit many patients and health care budgets through improved clinical efficacy and cost-efficiency in the treatment of specific conditions, notably nonhealing diabetic ulceration of the lower limbs. This is not only disabling, it may lead to amputation. It is also a financial burden to patients and health service providers. In the UK, it is estimated that chronic wound care costs more than pound1 billion a year, with diabetic ulceration accounting for a substantial part of that staggering sum. It has been said repeatedly, and quite correctly, that there is insufficient good-quality evidence upon which a properly informed decision may be made on the contribution HBOT might make to alleviate that situation. It is intriguing that no determined effort is apparent that would seek to settle the issue by encouraging and facilitating appropriately designed and conducted randomized controlled trials to assess the actual effects of this treatment. Indeed, a proposed government research initiative appears to have been cancelled. Is lack of research preventing provision of HBOT?
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Affiliation(s)
- Grant McMillan
- Independent Practice in Occupational Medicine, Alverstoke, Hants, UK.
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Vidigal J, José Fagundes D, De Jesus Simões M, Oshima CTF, Odashiro AN, Santos Simões R, Negrini Fagundes AT, Taha MO, Montero EFDS. Effect of different periods of hyperbaric oxygen on ischemia-reperfusion injury of rat skeletal muscle. Microsurgery 2007; 27:252-7. [PMID: 17477427 DOI: 10.1002/micr.20350] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The effect of hyperbaric oxygen (HBO) on ischemia-reperfusion injury of skeletal muscle, applied during different periods, was studied in 56 male rats. Animals were subjected to 6-h ischemia by a tourniquet over the major femoral trocanter and 4 (A) or 24 (B) h of reperfusion. HBO was carried out during 1 h in an acrylic chamber at a pressure of 2.0 ATA (100% oxygen): in the last 60 min of ischemia (II), after ischemia, during 1-h reperfusion time (III), and during the last hour of ischemia plus 1-h reperfusion (IV). Group I was the control group. After 4- or 24-h reperfusion, samples of the soleus muscle were stained by H&E and analyzed immunohistochemically. No interstitial hemorrhage, neutrophil infiltrate, or cellular necrosis were induced by HBO. The apoptosis index did not differ among the groups. HBO reduced morphologic alterations and promoted better results when administered in the ischemia plus reperfusion period (GIV).
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Affiliation(s)
- João Vidigal
- Orthopedic Division, Medical School of Federal University of Grande Dourados, Mato Grosso do Sul, Brazil
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Saito S, Nishikawa K, Obata H, Goto F. Autologous bone marrow transplantation and hyperbaric oxygen therapy for patients with thromboangiitis obliterans. Angiology 2007; 58:429-34. [PMID: 17652224 DOI: 10.1177/0003319706292015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many patients suffering from severe ischemic limb disease inevitably experience amputation, despite intensive therapies. Sympathectomy and hyperbaric oxygen therapy are optional therapies for patients with peripheral circulation disorders. Recently, several clinical studies have established that implantation of bone marrow-mononuclear cells into ischemic limbs increases collateral vessel formation. In the present study, autologous implantation of bone marrow-mononuclear cells was prescribed to 7 patients with ischemic limbs because of peripheral arterial disease. Although the extent of the improvement was not consistent among the 7 cases, all of the patients experienced some improvement in their symptoms. Transcutaneous oxygen partial pressure measured in a hyperbaric chamber increased in 5 patients. No side effects were observed. In conclusion, combined use of autologous bone marrow transplantation and hyperbaric oxygen therapy may be safe and effective for achievement of therapeutic angiogenesis.
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Affiliation(s)
- Shigeru Saito
- Department of Anesthesiology, Gunma University Graduate School of Medicine, Maebashi, Japan. -u.ac.jp
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Abstract
Emergency physicians treat millions of wounds annually in the United States. In 2004 approximately 6.4 million open wounds were seen in United States emergency departments, representing approximately 5.8% of all visits. This article discusses difficult traumatic wounds that emergency physicians encounter on a daily basis, including mammalian bites, puncture and high-pressure wounds, and crush injuries, with special emphasis given to individuals at high risk for infectious complications. Information is provided on epidemiology, pathophysiology, management, and treatment of various complicated wounds. The authors highlight available guidelines, provide the best evidence available, and provide recommendations when data are limited.
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Affiliation(s)
- Vincent Ball
- Department of Emergency Medicine, Madigan Army Medical Center, Building 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA
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Chen YC, Chen SY, Ho PS, Lin CH, Cheng YY, Wang JK, Sytwu HK. Apoptosis of T-leukemia and B-myeloma cancer cells induced by hyperbaric oxygen increased phosphorylation of p38 MAPK. Leuk Res 2006; 31:805-15. [PMID: 17064767 DOI: 10.1016/j.leukres.2006.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Revised: 09/11/2006] [Accepted: 09/13/2006] [Indexed: 10/24/2022]
Abstract
Tumor cells with different origins have different threshold to apoptosis. Hematopoietic (Jurkat, NCI-H929) cells and non-hematopoietic (A549, MCF-7) cells were received hyperbaric oxygen (HBO(2)) treatment from 2.5 to 3.5 atmosphere absolute (ATA) of 100% oxygen for 6h, and a significant percentage of apoptosis were shown only in hematopoietic Jurkat and NCI-H929 cells by either Annexin V or TUNEL assay. Oxidative stress was illustrated higher in HBO(2)-treated hematopoietic cells by superoxide fluorochrome detectors. HBO(2) treatment leads to caspase-3, caspase-7 activation and further cleavage of PARP within cells. Furthermore, the increased phosphorylation of p38 MAPK was demonstrated in both Jurkat and NCI-H929 cells.
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Affiliation(s)
- Yen-Chen Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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