NECROTIZING SOFT TISSUE INFECTIONS (Subcutaneous Tissue, Muscle, Fascia)

Hyperbaric oxygen therapy may be used as an adjunct to surgical and antibiotic treatment of soft tissue infections, with tissue necrosis, due to mixed aerobic and anaerobic organisms. These conditions include necrotizing cellulitis, progressive dermal gangrene, and severe cases of anaerobic streptococcal myositis, crepitant anaerobic cellulitis, and necrotizing fasciitis.

RATIONALE: Organisms other than clostridia can cause necrotizing infections. In these synergistic situations one characteristic is the presence of bacterial species with differing oxygen requirements. Favorable clinical reports indicate an adjunctive role for hyperbaric oxygen in these difficult and often life- or limb-threatening infections. Primary management remains adequate surgical debridement and antibiotic coverage. Hyperbaric oxygen is a useful adjunct in difficult cases. The oxygen tension in infected tissues is low. Increasing tissue oxygen tensions enhances white cell killing of bacteria, promotes inhibition of anaerobic organism growth, and increases the oxidation reduction potential. The high mortality and morbidity associated with these conditions warrant the addition of adjunctive hyperbaric oxygen therapy.

SOURCE: UHMS Publication CR(HBO) 1996

ENHANCEMENT OF HEALING IN SELECTED PROBLEM WOUNDS

Problem wound is an often used term to describe a group of hypoxic and/or hypoperfused wounds which have failed standard medical and surgical therapy. These include diabetic wounds, dehiscent amputation sites, non-healing traumatic wounds, and vascular insufficiency ulcers. All of these wounds have the underlying problem of tissue hypoxia, with oxygen tension usually below 20 mmHg, and, therefore, are more prone to infection.

RATIONALE: The elevation of oxygen tension by hyperbaric oxygen therapy has powerful effects on wound dynamics. Hyperbaric oxygen enhances leukocyte bactericidal activity and promotes the fibroblast-collagen support needed for neovascularization. Hyperbaric oxygen therapy for difficult wounds should be undertaken with the clear understanding that it must be part of a vigorous and coordinated surgical team approach to total patient management.

SOURCE: UHMS Publication CR(HBO) 1996

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