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G. Melian,D. Gogalniceanu,Carmen Vicol,Otilia Lupascu
Jurnalul de Chirurgie , 2005,
Abstract: Necrotizing fasciitis is a severe group A -hemolytic streptococcus infection that leads to necrosis of the subcutaneous tissue, adjacent fascia and blood vessels. It is a rare, rapidly progressing condition, with a poor prognosis and a mortality rate as high as 74%. Over a period of 11 years, 4616 with odontogenic infections were admitted to O.M.F. Surgery Department of Iasi. Out of these 4616 patients, we established the necrotizing fasciitis diagnosis just in 4 cases. Treatment must be immediately initiated consisting in oro-tracheal intubation, cardiovascular monitoring, antibiotherapy, large surgical debridement and excision of necrotic tissue, hyperbaric oxygen therapy. After acute inflammation resolution, skin surgical reconstruction is needed.
Hyperbaric oxygen therapy in diabetic foot.
Doctor N,Pandya S,Supe A
Journal of Postgraduate Medicine , 1992,
Abstract: To study the effect of hyperbaric oxygen therapy in chronic diabetic foot lesions, a prospective controlled study was undertaken. Thirty diabetics with chronic foot lesions were randomised to study group (conventional management and 4 sessions of hyperbaric oxygen therapy) and control group (conventional management). The patients were assessed for average hospital stay, control of infection and wound healing. The control of infection spread was quicker. Positive cultures decreased from initial 19 to 3 in study group as against from 16 to 12 in the control group. (p < 0.05). This difference was most pronounced for Escherichia coli. Also, the need for major amputation was significantly less in the study group (n = 2) as against the control group (n = 7) (p < 0.05). The average hospital stay was not affected. We conclude that hyperbaric oxygen therapy can be safely used and is beneficial as an adjuvant therapy in chronic diabetic foot lesions.
Hyperbaric oxygen therapy in the surgical approach to an irradiated patient  [PDF]
Hécio Henrique Araújo de Morais,Belmiro Cavalcanti do Egito Vasconcelos,Ricardo José de Holanda Vasconcelos,Ant?nio Figueiredo Caubi
RGO : Revista Gaúcha de Odontologia , 2008,
Abstract: Cancer is the terminology applied to a set of more than one hundred diseases that have disorderly cell growth in common. The treatmentof cancer can be performed by surgery, radiotherapy, chemotherapy, or bone marrow transplant. In the region of the head and neck,radiotherapy results in a series of complications in the patient, such as hypovascularization of the irradiated tissues, with reduced demand of oxygen and cells, and there is risk of the occurrence of osteoradionecrosis after tooth extraction, leading to the need for a differentiated approach to these patients. Of the therapeutic conduct adopted in the approach to irradiated patients, hyperbaric oxygen therapy is a well established resource, as the therapeutic principle of this modality enables the restoration of an adequate process of tissue repair. In this study, a clinical case is related, of the use of hyperbaric oxygen therapy as an adjuvant procedure, before and after multiple tooth extractions, in a patient irradiated in the head and neck region, obtaining success with cicatricial repair without complications.
Hyperbaric Oxygen Therapy: An Overview  [cached]
Surjit Singh, Shikha Baisakhiya*, Vishal Goel ,Suvidha Shoric
Current Trends in Biotechnology and Chemical Research , 2012,
Abstract: Hyperbaric oxygen therapy (HBO) is a form of treatment in which a patient breathes 100% oxygen at higher than normal atmospheric pressure that is greater than 1 atmosphere absolute (ATA). Higher barometric pressure is used for delivering increased concentration of oxygen dissolved in plasma. Therapy is administered by special therapeutic chambers, which may be rigid or flexible. The therapy has been used over the last four decades for several medical indications. The lack of adequate scientific validation regarding efficacy and safety of treatment led to the lack of interest of physicians in this modality of treatment. Although in the last two decades, experimental studies on animals and clinical trials have produced validated scientific evidence and this has led to a renaissance of HBO, and hyperbaric facilities now form an important part of many hospitals all over the world. The aim of this overview is to summarize the mechanism of action, indications, contraindications and possible complications of hyperbaric oxygen therapy.
Hyperbaric Oxygen Therapy of Ischemic Cranial Skin Flap: Case Report and Review of the Literature  [PDF]
Fassil B. Mesfin, Matthew R. Burton, Ruben A. Ngnitewe Massa, Jeffery S. Litt
Case Reports in Clinical Medicine (CRCM) , 2017, DOI: 10.4236/crcm.2017.610028
Abstract: Hyperbaric Oxygen Therapy (HBOT) is a medical procedure and therapeutic modality that utilizes 100% oxygen. HBOT has been used various medical conditions such as progressive necrotizing fasciitis, peripheral arterial insufficiency, and diabetic wounds of the lower extremities. The case report reported here describes the usage of HBOT as an adjunctive “rescue” measure to salvage a patient’s cranioplasty scalp flap after flap ischemia was noted 2 days post-operatively. Patient is a 54 year-old caucasian female who presented to our facility with symptoms of a left MCA infarct. CT and MRI of her brain revealed a left MCA infarct with hemorrhagic stroke with significant cerebral edema, and midline shift. She was taken to the operating room for a left decompressive hemi-craniectomy. She had cranioplasty utilizing native bone flap delayed fashion. She had wound infection after cranioplasty which required removal of native bone. After appropriate treatment for infection, she had cranioplasty utilizing prosthetic Biomet implant. Post-cranioplasty, patient developed ischemic cranial flap. This was recognized within 48 hrs and HBOT was implemented. She has a successful rescue of the ischemic cranial flap after she received 14 consecutive treatments over two weeks. In our knowledge, this is the first successful treatment of HBOT reported after prosthetic cranioplasty for scalp flap ischemia.
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  [cached]
Pastore Antonio Luigi,Palleschi Giovanni,Ripoli Andrea,Silvestri Luigi
Journal of Medical Case Reports , 2013, DOI: 10.1186/1752-1947-7-1
Abstract: Introduction 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. Case presentation 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. Conclusions 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.
Hyperbaric Oxygen Therapy: Focus  [PDF]
Ahmed Amine El Oumri, Hiba Badi, Saloua Khaloufi
Open Journal of Emergency Medicine (OJEM) , 2018, DOI: 10.4236/ojem.2018.61003
Hyperbaric oxygen therapy is now an integral part of the current therapeutic arsenal, it is a treatment that has a large number of indications and which concerns several specialties. This development aims to summarize some main indications.
Prognostic factors and monomicrobial necrotizing fasciitis: gram-positive versus gram-negative pathogens
Ching-Yu Lee, Liang-Tseng Kuo, Kuo-Ti Peng, Wei-Hsiu Hsu, Tsan-Wen Huang, Ying-Chao Chou
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-5
Abstract: Forty-six patients with monomicrobial necrotizing fasciitis were examined retrospectively from November 2002 to January 2008. All patients received adequate broad-spectrum antibiotic therapy, aggressive resuscitation, prompt radical debridement and adjuvant hyperbaric oxygen therapy. Eleven patients were infected with a gram-positive pathogen (Group 1) and 35 patients with a gram-negative pathogen (Group 2).Group 2 was characterized by a higher incidence of hemorrhagic bullae and septic shock, higher APACHE II scores at 24 h post-admission, a higher rate of thrombocytopenia, and a higher prevalence of chronic liver dysfunction. Gouty arthritis was more prevalent in Group 1. For non-survivors, the incidences of chronic liver dysfunction, chronic renal failure and thrombocytopenia were higher in comparison with those for survivors. Lower level of serum albumin was also demonstrated in the non-survivors as compared to those in survivors.Pre-existing chronic liver dysfunction, chronic renal failure, thrombocytopenia and hypoalbuminemia, and post-operative dependence on mechanical ventilation represent poor prognostic factors in monomicrobial necrotizing fasciitis. Patients with gram-negative monobacterial necrotizing fasciitis present with more fulminant sepsis.Necrotizing fasciitis is characterized by a rapidly spreading necrosis of the superficial fascia and subcutaneous tissue and is associated with a high mortality despite aggressive surgical treatment and adequate parenteral antibiotic therapy [1]. This disease is generally classified into the following categories: Type 1 (polymicrobial infection), Type 2 (infection with a Group A β-haemolytic Streptococcus or Staphylococcus aureus), and Type 3 (infection with a gram-negative bacillus such as Vibrio) [2-4]. The incidence of monomicrobial necrotizing fasciitis has recently increased [5-8]. The soft tissue necrosis that typifies these infections is attributable to the release of endotoxins, exotoxins and proteases th
Hyperbaric oxygen therapy and its mechanisms of action: implication of several molecular processes along with reactive species
Kemal Simsek,Sukru Oter,Hakan Ay
Journal of Experimental and Integrative Medicine , 2011,
Abstract: Hyperbaric oxygen (HBO2) treatment is an interesting therapeutic modality (HBOT; hyperbaric oxygen therapy) in which the patient breathes 100% oxygen while exposed to increased atmospheric pressure. Generally, the therapeutic mechanisms for HBOT have been based on both the increased ambient pressure and the elevated partial oxygen pressure (pO2). Increasing the ambient pressure leads to reduction in the volume of gas-filled spaces according to Boyle’s law. This action is directly related to the treatment of pathological conditions in which gas bubbles are present in the patient’s body, i.e., decompression sickness or gas embolism. However, most of the pathologies for which HBOT is used rely on an inflammatory background and have no pathophysiologic relation with gas bubbles. Thus, the mechanistic basis of HBOT in indications such as problematic wounds, traumatic injuries, necrotizing fasciitis, ischemia-reperfusion processes, refractory osteomyelitis, and compromised flap and grafts depends on the elevation in pO2 in bodily fluids and tissues. Oxygen is needed to support cellular respiration and consequently provides energy. Reduced delivery of oxygen... [J Exp Integr Med 2011; 1(4.000): 205-206]
Prevention of avascular necrosis in displaced talar neck fractures by hyperbaric oxygenation therapy: A dual case report  [cached]
Mei-Dan O,Hetsroni I,Mann G,Melamed Y
Journal of Postgraduate Medicine , 2008,
Abstract: Talar neck fractures are a rare injury that account for less then 2% of all foot fractures. Displaced fractures are associated with an exceedingly high rate of avascular necrosis (AVN). The incidence of AVN following Hawkins Type 3 fractures of the talar neck may approach 100%, particularly if diagnosis and reduction are delayed. Severe cases may present as pain and disability of the ankle and the subtalar joints due to a talar dome collapse, resulting in degenerative changes that usually require hind foot arthrodesis. We present two cases of traumatic displaced talar neck fractures which were treated surgically more than 2 weeks following injury due to a delay in diagnosis. Both patients underwent hyperbaric oxygen therapy (HBOT) after the operation and neither resulted in AVN of the talus in a three-year follow-up. We suggest that this favorable result may be due to the beneficial effects of HBOT.
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