Crush Injury and Other Acute Traumatic Ischemia

Kemmer, A.

doi:10.1007/1-4020-4448-8_17

Cited by 7 publications

(9 citation statements)

References 17 publications

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“…HBO therapy as an adjunct should be administered as early as possible to minimize the frequency and extent of tissue necrosis, reduce edema, control infection, support healing and prevent reperfusion injury. [9] A recent retrospective analysis of 70 consecutive sural flaps reported a complication rate of 59% (41 of 70 flaps), with complete necrosis in 19% flaps and partial necrosis in 17%. [10] In a series of lateral supramalleolar flaps by Ehab et al, [6] a total of 5 patients (20%) suffered complications out of 25 patients.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Korambayil¹,

Ambookan²

2015

Plast Aesthet Res

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Aim: The purpose of the study is to present a management protocol for various types of soft tissue defects of the distal third region of leg and foot treated with pedicle flaps, by including hyperbaric oxygen (HBO) therapy in the treatment regimen with flap delay. Methods: We present a prospective study of 23 patients with various types of soft tissue defects of the foot, and lower third of leg managed in our institution from December 2012 to December 2013. All soft tissue defects were treated by a reverse pedicle flap. Twelve patients were managed with flap delay with HBO therapy and 11 patients with immediate flaps without HBO therapy. The postoperative period, hospital course, and follow-up were documented. Results: Of 12 patients with flap delay and HBO, 10 patients did not suffer any complications secondary to flap transfer. One patient had discoloration of the tip of the flap, which settled without the intervention, and 1 patient had recurrent abscess formation, which required debridement and closure. Of 11 patients with direct transfer, 6 patients presented with complications including flap congestion, partial flap loss, and tip necrosis, which required secondary intervention. Conclusion: HBO therapy is a useful adjunct in flap delay of the reverse pedicle flap for soft tissue reconstruction of the lower third of the leg and foot regions.

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Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Korambayil¹,

Ambookan²

2015

Plast Aesthet Res

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“…Adjuvant HBO can be given early to prevent large regions of ischemic necrosis, minimize the frequency and extent of tissue necrosis, reduce edema, control infection, support healing, and prevent reperfusion injury. [9] At the authors' institution, a strategy has been developed to overcome these difficulties and to successfully manage these patients with a combined approach that maximizes tissue perfusion and oxygenation, allowing for surgical correction of such injuries. The current treatment algorithm [ Figure 6] begins with surgical debridement and initiation of HBO therapy in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Heel pad avulsion injury: an approach with hyperbaric oxygen therapy

Mukundan

Ambookan

2015

Plast Aesthet Res

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Aim: Crush injuries of the foot are often associated with partial or complete degloving of the heel pad. The purpose of this study is to present an algorithm for the management of various types of heel pad avulsion injuries, including hyperbaric oxygen (HBO) therapy in the treatment regimen. Methods: We present a prospective study of 27 patients with various types of heel pad avulsion managed in our institution from December 2012 to June 2013. Heel pad avulsion injuries were classified according to the angiosomal pattern. Partial or complete avulsions were classified and treated accordingly. HBO therapy was administered postoperatively. The postoperative period, hospital course, and follow-up were documented in patients with heel pad avulsion injuries. Results: Of 27 patients, 20 cases presented with partial avulsion and 7 cases were complete avulsion. Of 20 cases of partial avulsion, one of the flaps was anchored with K-wire. Nineteen cases of partial heel pad avulsion were managed by suturing. Eight patients out of 20 required skin grafting as a secondary procedure at a later date. Out of 7 cases of complete avulsion, one was managed by full-thickness skin grafting, one case by reverse sural artery flap coverage, and four cases were managed by free tissue transfer. No flap revisions were required, and no complications were experienced for the transferred flaps. Conclusion: HBO therapy may be a useful adjunct in the treatment of heel pad avulsion injuries.

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“…[1,3] Traumatic wounds: Crush injury, compartment syndrome Hyperbaric oxygen ameliorates the effects of acute traumatic ischaemia through four mechanisms: hyperoxygenation, vasoconstriction, and influence on reperfusion and host factors. [18] HBOT also decreases neutrophil activation, preventing margination, rolling and Figure 1: Flow chart for patient selection and predictor of outcomes in patients managed with HBOT based on transcutaneous oximetry measurements [15,16] accumulation of WBCs, thereby reducing the production of free radicals by neutrophils and preventing reperfusion injury. [3] HBOT is also seen to reduce sludging of RBCs.…”

Section: Non-healing Wounds: Diabetic Vascular Insuffi Ciency Ulcersmentioning

confidence: 99%

“…Adjuvant HBOT should be administered as soon as possible; when it is given early it can prevent large expanses of ischaemic necrosis, minimise the frequency and extent of amputations, reduce oedema, control infection, support healing and prevent reperfusion injury. [18] Gustilo classification of open fractures is commonly used for objective assessment in crush injuries to determine whether HBOT is indicated or not. For the uncompromised host, HBOT is recommended for all Gustilo Grade III B and III C fractures.…”

Section: Non-healing Wounds: Diabetic Vascular Insuffi Ciency Ulcersmentioning

confidence: 99%

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Hyperbaric oxygen and wound healing

Bhutani¹,

Vishwanath

2012

Indian J Plast Surg

121

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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. 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.

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Crush Injury and Other Acute Traumatic Ischemia

Cited by 7 publications

References 17 publications

Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Hyperbaric oxygen therapy and surgical delay improve flap survival of reverse pedicle flaps for lower third leg and foot reconstruction

Heel pad avulsion injury: an approach with hyperbaric oxygen therapy

Hyperbaric oxygen and wound healing

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