Adjunctive hyperbaric oxygen therapy for irradiated rat calvarial defects

Effective administration of cranial drilling therapy in the treatment of fourth degree temporal, facial and upper limb burns at high altitude: A case report

BACKGROUND

Fourth degree burns damage the full thickness of the skin and affect underlying tissues. Skin grafting after debridement is often used to cover the wounds of salvageable severe burns. A granulation wound can be formed by drilling the skull to the barrier layer to solve the problem of skull exposure. Low oxygen levels present at high altitudes aggravate ischemia and hypoxia which can negatively impact wound healing. The impaired healing in such cases can be ameliorated by hyperbaric oxygen therapy.

CASE SUMMARY

We describe a patient who presented with fourth degree burns to the left temporal and facial regions upon admission in December 2018. The periosteum of the skull and the deep fascia of the face were exposed. After the first stage of debridement and skin grafting, the temporal skin did not survive well. Granulation was induced by cranial drilling, and then a local flap was transferred to cover the wound. The left temporal and facial wounds were completely covered and the patient recovered well.

CONCLUSION

Skin grafting and flap transfer after early debridement to cover the wound and control infection were of great significance. In the later stages of the patient’s treatment, survival of the skin graft and skin flap was observed. The second stage repair was performed to achieve successful skin grafting by cranial granulation. Granulation was formed by drilling the skull, and then the wound was closed, which is suitable for cases with skull exposure and wounds with poor blood supply. We consider that hyperbaric oxygen treatment and improving tissue oxygen supply were beneficial in this patient.

The effect of hyperbaric oxygen therapy on bone macroscopy, composition and biomechanical properties after ionizing radiation injury

Background

Radiotherapy used in tumor treatment compromises vascularization of bone tissue. Hyperbaric oxygenation (HBO) increases oxygen availability and improves vascularization, minimizing the deleterious effects of ionizing radiation (IR). Therefore, the aim of this study was to evaluate HBO therapy effect on bone macroscopy, composition and biomechanical properties after IR damage.

Methods

Twenty male Wistar rats weighing 300 ± 20 g (10 weeks of age) were submitted to IR (30 Gy) to the left leg, where the right leg was not irradiated. After 30 days, ten animals were submitted to HBO therapy, which was performed daily for 1 week at 250 kPa for 90-min sessions. All animals were euthanized 37 days after irradiation and the tibia were separated into four groups (n = 10): from animals without HBO - right tibia Non-irradiated (noIRnoHBO) and left tibia Irradiated (IRnoHBO); and from animals with HBO - right tibiae Non-irradiated (noIRHBO) and left tibia Irradiated (IRHBO). The length (proximal-distal) and thickness (anteroposterior and mediolateral) of the tibiae were measured. Biomechanical analysis evaluated flexural strength and stiffness. Attenuated Total Reflectance Fourier Transform Infrared Spectroscopy (ATR-FTIR) was used to calculate the amide I ratio, crystallinity index, and matrix to mineral ratios.

Results

In the macroscopic and ATR-FTIR analysis, the IRnoHBO showed lower values of length, thickness and amide I ratio, crystallinity index and matrix to mineral ratios compared to noIRnoHBO (p < 0.03). IRnoHBO showed no statistical difference compared to IRHBO for these analyses (p > 0.05). Biomechanics analysis showed that the IRnoHBO group had lower values of flexural strength and stiffness compared to noIRnoHBO and IRHBO groups (p < 0.04). In addition, the noIRHBO group showed higher value of flexural strength when compared to noIRnoHBO and IRHBO groups (p < 0.02).

Conclusions

The present study concluded that IR arrests bone development, decreases the collagen maturation and mineral deposition process, thus reducing the flexural strength and stiffness bone mechanical parameters. Moreover, HBO therapy minimizes deleterious effects of irradiation on flexural strength and the bone stiffness analysis.