Hyperbaric Oxygen Therapy for Traumatic Ischemia: Three Year Experience of a University Hospital

Abstract

Introduction Acute traumatic ischemia (ATI) involving crush injuries, compartment syndromes or threatened flaps is a condition where survival of the traumatized tissue is at risk mainly due to compromised circulation. Hyperbaric oxygen therapy (HBOT) has been recommended for these injuries in order to enhance tissue viability. Methods Patients who were treated for ATI in our department from 1.1.2013 to 31.12.2015 were reviewed retrospectively. Demographic data of patients, injury sites, injury cause, time to HBO treatment and outcomes were evaluated. Relation between HBO timing, HBO sessions and outcomes were analyzed. Results Seventy five patients (18 female, 57 male) were treated for ATI. Mean age of patients was 28 and 37 % were less than 18 years of age. Sixty four percent of ATIs was crush injury with open fracture. The most common causes of injury were trauma by falling object (49%) and car accidents (43 %). There were two patients injured in a bombing attack. The injuries involved the feet for forty (54%) of patients. Of these, twelve had digital sub-amputations. Three patients had multiple injuries. Time to HBOT after injury was less than 8 hours for thirty three patients (43%), between 8 to 16 hours for 17 patients (23%) and more than 16 hours for the rest. Mean HBO sessions applied was 14. Seventy patients (93 %) healed without further major amputation. Discussion HBO is an effective adjuvant therapy for traumatic ischemia management. Early referral and frequent applications in acute phase may improve the outcome. Keywords Hyperbaric oxygen, crush, trauma