Aim: Snakebite injuries of the extremities are common in tropical India among those involved in farming and outdoor activities. These injuries often complicated by cellulitis, gangrene, regional lymphadenopathy, compartment syndrome, bleeding abnormalities, septicemia, hypotension, and disseminated intravascular coagulation, resulting in significant morbidity and mortality. The purpose of the study is to share our experience of hyperbaric oxygen (HBO) therapy in the management of snakebite injuries. Methods: All patients who were treated for snakebite injuries in our department between October 2012 and October 2013 were included in the study. Results: Out of a total 395 patients, 174 patients treated with anti-snake venom with a mortality of 17 posttreatment. Forty-four out of the 174 patients was in the pediatric age group. Out of the patients referred to our department, 23 presented with cellulitis, 7 with compartment syndrome and 17 for the management of soft tissue cover over the extremities. Of the 47 patients, 30 involved the lower extremity and rest involved the upper extremity. All patients were subjected to HBO therapy as an adjunct. Six patients required flap cover: cross finger flap (n = 2), anterolateral thigh free tissue transfer (n = 1), lateral supramalleolar flap (n = 1), groin flap (n = 1), and dorsal metacarpal artery flap (n = 1). There was no need for fasciotomy among the patients who suffered impending compartment syndrome. Conclusion: HBO therapy may reduce the incidence of fasciotomy and increase the effectiveness of plastic surgical modalities if administered early and may be used as a useful adjunct in the management of snake envenomation injury.
Aim: Scrotal soft tissue loss is a part of the challenging conditions for plastic surgeon. The nonavailability of adequate nearby healthy soft tissue and its probability of frequent contamination by excretory substances make the issue of reconstruction complicated. The authors present their experience with penoscrotal soft tissue loss with hyperbaric oxygen therapy as an adjunct. Methods: This retrospective study was undertaken in the department of plastic surgery, over a period of 2 years. Nine patients with scrotal or penile injury and infection were enrolled in the study. Age of the patients ranged 20-60 years. Five patients had traumatic loss of scrotal skin and 4 resulted following necrotizing soft tissue infection. All patients underwent hyperbaric oxygen therapy before and following surgery. Results: Healing was complete in all patients with minor complications as partial skin graft loss in 2 patients. Five patients (55.5%) had sustained the soft tissue loss due to trauma. The cause of necrotizing fasciitis was found in 4 patients (44.4%). The mean length of hospital stay was 42.5 days. Conclusion: Management of soft tissue loss of penoscrotal region requires an organized approach and the utilization of newer modalities for early recovery of these injuries is of primary need. Operating surgeons should know the various reconstructive pathways and use of adjunct measures like hyperbaric therapy for early recovery.
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