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HBOT AND TRAUMA( CRUSH INJURIES , COMPARTMENT SYNDROME ,OTHER TRAUMATIC PERIPHRAL ISCHEMIAS) AND WOUND HEALING
Crush injuries, compartment syndromes and other acute traumatic peripheral
ischaemias
A “crush injury” is the direct result of an injury where there is tissue destruction by
high energy transfer to the tissue and or interruption of blood vessels, resulting in a
vicious spiral which causes ischemia, hypoxia, edema, disturbed microcirculation,
and leads to secondary ischemia in the border area of the tissue affected by primary
trauma. There is thus usually a “gradient of injury” which contains the spectrum from
dead (or necrotic) to living tissue of which the compromised (but not necrotic)
component may vary significantly depending on the type of traumatic injury. The
latter can include other forms of trauma and even frost bite, burns and a number of
non-mechanical traumas.
This is commonly complicated by stasis in the
microcirculation, reperfusion injury, and secondary infection, non-healing and non
union all potentially resulting in delayed loss of tissue. Garcia, et al published an
evidenced based approach for the use of hyperbaric oxygen therapy in the
management of crush injuries and traumatic ischaemias. They found that eight
studies showed beneficial effects of hyperbaric oxygen therapy with only one
reported major complication. From these eight studies however, only one was a
randomized, double-blinded placebo-controlled study[36], which indicated tha
hyperbaric oxygen therapy can be effectively applied for crush injuries.
Enhancement of healing in selected problem wounds
Many case reports and case-series demonstrate the beneficial effects of hyperbaric
oxygen therapy in diabetic foot ulcers. The first controlled trial of hyperbaric oxygen
therapy in lower extremity wounds was published nearly 30 years ago. Since then
there have been several prospective, randomized, controlled trials in non-healing
diabetic foot ulcers. Outcome measures in these clinical trials vary from one
study to another. The systematic review of some of these trials provides evidence
that, for patients with diabetic ulcers resistant to standard care, hyperbaric oxygen
therapy decrease the risk of major amputation. The findings that oxygen tensions
around the ulcers are significantly raised following a course hyperbaric oxygen
therapy supports a mechanism for this benefit. Transcutaneous oximetry is used as
part of the assessment of problem wounds and provides an objective basis for
decision-making. A Cochrane Review summarizes the evidence in RCT’s of
hyperbaric oxygen therapy for chronic diabetic ulcers: “There is a strong case for
further large randomized trials of high methodological rigour in order to define the
true extent of benefit from administration of hyperbaric oxygen therapy”.
Hyperbaric oxygen therapy also showed to be beneficial in treating patients with
other non diabetic wound ulcers
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