Article – 1 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Hyperbaric oxygen and wound healing.
Authors: Bhutani S, Vishwanath G.
Digital Object Identifier (or PMID etc): PMID: 23162231 PMCID: PMC3495382
Keywords: Air embolism; compartment syndrome; crush syndrome; decompression sickness; diabetes mellitus; diabetic foot; gas gangrene; hyperbaric; hyperbaric medicine; hyperbaric oxygen therapy; hyperbaric oxygenation; necrotising fasciitis; osteomyelitis; osteoradionecrosis; radiation injuries; radiation necrosis; reperfusion injury; soft tissue infections; surgical flaps; transcutaneous oximetry
Abstract: Hyperbaric oxygen therapy (HBOT) is the use of 100% oxygen at pressures greater than atmospheric pressure. Today several approved applications and indications exist for HBOT. HBOT has been successfully used as adjunctive therapy for wound healing. Non-healing wounds such as diabetic and vascular insufficiency ulcers have been one major area of study for hyperbaric physicians where use of HBOT as an adjunct has been approved for use by way of various studies and trials. HBOT is also indicated for infected wounds like clostridial myonecrosis, necrotising soft tissue infections, Fournier's gangrene, as also for traumatic wounds, crush injury, compartment syndrome, compromised skin grafts and flaps and thermal burns. Another major area of application of HBOT is radiation-induced wounds, specifically osteoradionecrosis of mandible, radiation cystitis and radiation proctitis.
Conclusion: With the increase in availability of chambers across the country, and with increasing number of studies proving the benefits of adjunctive use for various kinds of wounds and other indications, HBOT should be considered in these situations as an essential part of the overall management strategy for the treating surgeon.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/23162231
Full text URL:
Article – 2 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute.
Authors: Waisman D1, Shupak A, Weisz G, Melamed Y.
Digital Object Identifier (or PMID etc): PMID: 9794983
Keywords: Adolescent, Carbon Monoxide Poisoning/therapy, Child, Child, Preschool, Crush Syndrome/therapy, Decompression Sickness/therapy, Embolism, Air/therapy, Fasciitis, Necrotizing/therapy, Female, Hospitals, Military, Humans, Hyperbaric Oxygenation/adverse effects, Hyperbaric Oxygenation/statistics & numerical data, Infant, Ischemia/therapy, Israel, Male, Naval Medicine, Necrosis, Purpura, Schoenlein-Henoch/therapy, Retrospective Studies
Abstract: The pediatric patient is to be found in hyperbaric facilities throughout the world, receiving hyperbaric oxygen (HBO) therapy for both life-threatening and chronic diseases. To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients. A retrospective analysis and review of all records of patients younger than age 18 years.
Results: Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 years) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) poisoning; 13 (9.2%) were treated after crush injury, traumatic ischemia, or compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 (1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminans; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1.4%) died, 1 as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic sequelae, and 6 patients in the acute traumatic ischemia group (4.3%) underwent limb amputation.
Conclusion: We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refer the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific skills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is essential to ensure adequate care for infants and children.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/9794983
Full text URL:
http://pediatrics.aappublications.org/content/102/5/e53.long
Article – 3 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Gas Gangrene - Clostridial Myonecrosis: A Review.
Authors: Hart, GB; Strauss, MB
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Bottini demonstrated the bacterial nature of gas gangrene in 1871 but failed to isolate a causal organism. The first description of "gas gangrene” with accurate clinical, bacteriologic, and pathologic observations was made by Welch and Nuttall in 1892. This was further expanded by Welch’s later report in 1900. Gas gangrene is herein defined as that fulminate necrotizing infection caused by Clostridia and may or may not have gas in the involved tissues. The most frequent species of Clostridia causing gas gangrene was first designated Clostridium welchii following the aforementioned publications. However, at present this species is known as C perfringens and is generally accepted as being the most common and virulent form of gas gangrene. Early diagnosis is the most crucial part of successfully managing gas gangrene. Surgery and antibiotics remain the cornerstones of treating clostridial myonecrosis, but hyperbaric oxygen has proven to be a valuable adjunct (34-37).
Conclusion: In summary, the reviewed studies indicate that HBO when applied early as an adjunct to antibiotics and surgery is the present standard of care for gas gangrene.
Article – 4 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Hyperbaric oxygen therapy in orthopedic conditions.
Authors: Kawashima, M; Tamura, H; Nagayoshi, I; Takao, K; Yoshida, K; Yamaguchi, T
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: As is well known, the origins and development of hyperbaric medicine are closely tied to the history of diving medicine. Our HBO2 studies stemming from diving medicine date back to 1972. We concentrated our early basic research on dysbaric osteonecrosis. There are now good indications that HBO2 is helpful in a variety of orthopedic conditions.
Conclusion: However, hyperbaric medicine in orthopedics is still relatively new and some aspects of it remain controversial.
Article – 5 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: A multistep approach to manage Fournier's gangrene in a patient with unknown type II diabetes: surgery, hyperbaric oxygen, and vacuum-assisted closure therapy: a case report.
Authors: Pastore AL, Palleschi G, Ripoli A, Silvestri L, Leto A, Autieri D, Maggioni C, Moschese D, Petrozza V, Carbone A.
Digital Object Identifier (or PMID etc): PMID: 23286211 PMCID: PMC3572430
Keywords: Nil
Abstract: Fournier's gangrene is an infectious necrotizing fasciitis of the perineum and genital regions and has a high mortality rate. It is a synergistic infection caused by a mixture of aerobic and anaerobic organisms and predisposing factors, including diabetes mellitus, alcoholism, malnutrition, and low socioeconomic status. We report a case of Fournier's gangrene in a patient with unknown type II diabetes submitted to 24-hour catheterization 15 days before gangrene onset. The patient, a 60-year-old Caucasian man, presented with a swollen, edematous, emphysematous scrotum with a crepitant skin and a small circle of necrosis. A lack of resistance along the dartos fascia of the scrotum and Scarpa's lower abdominal wall fascia combined with the presence of gas and pus during the first surgical debridement also supported the diagnosis of Fournier's gangrene. On the basis of the microbiological culture, the patient was given multiple antibiotic therapy, combined hypoglycemic treatment, hyperbaric oxygen therapy, and several surgical debridements. After five days the infection was not completely controlled and a vacuum-assisted closure device therapy was started.
Conclusion: This report describes the successful multistep approach of an immediate surgical debridement combined with hyperbaric oxygen and negative pressure wound therapy. The vacuum-assisted closure is a well-known method used to treat complex wounds. In this case study, vacuum-assisted closure treatment was effective and the patient did not require reconstructive surgery. Our report shows that bladder catheterization, a minimally invasive maneuver, may also cause severe infective consequences in high-risk patients, such as patients with diabetes.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/23286211
Full text URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572430/
Article – 6 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Use of hyperbaric oxygen therapy in Hong Kong.
Authors: Ramaswami RA, Lo WK.
Digital Object Identifier (or PMID etc): PMID: 10793411
Keywords: Carbon Monoxide Poisoning/therapy, Compartment Syndromes/therapy, Crush Syndrome/therapy, Decompression Sickness/therapy, Fasciitis, Necrotizing/therapy, Gas Gangrene/therapy, Hong Kong, Humans, Hyperbaric Oxygenation, Osteomyelitis/therapy, Radiation Injuries/therapy
Abstract: The Recompression Treatment Centre on Stonecutters Island has been operating in Hong Kong for more than 5 years and has been used to treat a variety of diving-related and other conditions by means of hyperbaric oxygen therapy. Up to the end of December 1997, 295 treatment sessions had been conducted for 39 patients.
Conclusion: This article reviews the usefulness of and indications for hyperbaric oxygen therapy.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/10793411
Full text URL:
http://www.hkmj.org/article_pdfs/hkm0003p108.pdf
Article – 7 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Conservative surgical management of necrotic tissues following meningococcal sepsis: case report of a child treated with hyperbaric oxygen.
Authors: Takac, I; Kvolik, S; Divkovic, D; Kalajdzic-Candrlic, J; Puseljic, S; Izakovic, S
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: This article presents the case of a 5-month-old infant, who survived a fulminant meningococcal sepsis with purpura fulminans, septic shock and severe DIC with gastrointestinal bleeding. Amputation and reconstructive surgery were considered to treat the multiple skin and limb necroses at high risk of superinfection, but the surgical intervention was delayed due to the extremely doubtful outcome. On Day 10 after the onset of the disease, a hemodynamic improvement was achieved. The baby overcame early critical period, but was still in poor general condition. The hyperbaric oxygenation (HBO2) as adjuvant therapy was started in the monoplace chamber using the following protocol: from first through fifth day 45 minutes twice a day on 1.5 atmosphere absolute (ATA); after a two-day break, once a day on 1.8 ATA for 60 minutes. During 52 HBO2 treatments multiple areas of necrotic skin and subcutaneous tissue, together with fingertips and toes, detached spontaneously. All wounds healed without reinfections. An increased oxygen concentration during HBO2 therapy promoted spontaneous wound healing. Bacterial superinfection was not observed in numerous low-perfused lesions. Since repeated anesthesia and surgical interventions were not needed, a final invalidity was minimized.
Conclusion: To the best of our knowledge, this is the first report on the successful conservative surgical treatment of this mutilating disease without aggressive reconstructive surgery in an infant with the help of HBO2.
Article – 8 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Role of hyperbaric oxygen therapy in the rapid control of gas gangrene infection and its toxaemia.
Authors: Trivedi DR, Raut VV
Digital Object Identifier (or PMID etc): PMID: 2097348
Keywords: Adult, Child, Female, Gas Gangrene/therapy, Humans, Hyperbaric Oxygenation, Male
Abstract: Fifteen cases of proved gas gangrene infection were studied to assess the rapidity of control of infection and associated toxaemia, by hyperbaric oxygen therapy at 2 1/2 atmospheres pressure. Within 3-5 sittings, all the cases (100%) were found to become devoid of clostridial organisms as judged by smear and culture methods.
Source URL:
http://www.ncbi.nlm.nih.gov/pubmed/2097348
Full text URL:
Article – 9 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Management of Fournier's Gangrene and the role of Hyperbaric Oxygen.
Authors: Zamboni, WA; Riseman, JA; Kucan, JO
Digital Object Identifier (or PMID etc): Nil
Keywords: Nil
Abstract: Six male patients were treated for Fournier’s scrotal gangrene over a 2-yr period. All patients received hyperbaric oxygen (HBO) therapy in addition to surgical debridement and i.v. antibiotics. The 30-day mortality was zero, and only 1 late death from complications of pneumonia occurred. Prompt wound control was achieved in all 6 men and only 2 required more than 1 surgical debridement.
Conclusion: Important points in the management of this potentially devastating disease are discussed, including a review of the use of HBO.
Article – 10 – HBOT + Clostridial Myositis and Myonecrosis (gas gangrene)
Title: Hyperbaric Oxygen Therapy in Diabetic Gangrene.
Authors: Oriani, G; Meazza, D; Favales, F; Pizzi, GL; Aldeghi, A; Faglia, E
Digital Object Identifier (or PMID etc): Nil
Keywords: diabetic gangrene, hyperbaric oxygen, diabetic foot, microangiopathy
Abstract: Since 1982 we have used hyperbaric oxygen (HBO) therapy in the treatment of diabetic gangrene. We compared 2 groups of inpatients affected by this complication. The HBO group consisted of 62 subjects, 36 males, 26 females, and average age 52.7 yr; the non-HBO group (18 subject, 12 males, 6 females, average age 58.3 yr) declined to enter the hyperbaric chamber because of personal problems, such as claustrophobia. Incidences of long-term diabetic complications were the same in both groups, and a similar good metabolic control was obtained in all patients. In the 2 groups the morphologic characteristics of cutaneous gangrene were similar in size, depth, involvement of bones of feet, and presence of infection. In both groups the surgical treatment had been based on daily courettage in an attempt to remove any necrotic tissue. HBO therapy consisted of a daily treatment in a double-lock Drass chamber at 2 8-2.5 atm abs for 6 days a week till recovery, which occurred in 59 out 62 patients treated with HBO, with a total of 72 ± 28 treatments. The HBO group presented an amputation rate of 5% vs. 33% for the non-HBO group (P < 0.001).
Conclusion: Because of its effectiveness in reducing the incidence of amputations and their complications, our findings show that HBO therapy is indicated in diabetic gangrene in association with strict metabolic control and an accurate daily courettage.