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Hyperbaric oxygen adjuvant therapy in severe mangled extremities.
Puripun Jirangkul1, Sopon Baisopon2, Danai Pandaeng2
1Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Injury
|July 14, 2021
Summary
Hyperbaric Oxygen Therapy (HBOT) aids limb salvage in severe mangled extremities. This adjunctive treatment, alongside standard care, showed excellent outcomes and high limb salvage rates, even with high Mangled Extremity Severity Scores (MESS).
Area of Science:
- Trauma Surgery
- Hyperbaric Medicine
- Orthopedic Surgery
Background:
- The Mangled Extremity Severity Score (MESS) predicts amputation need in severe injuries (MESS ≥ 7).
- Severe crush and blast injuries pose challenges for limb salvage.
- Hyperbaric Oxygen Therapy (HBOT) is known for wound healing benefits.
Purpose of the Study:
- To evaluate adjuvant HBOT for severe mangled extremities prospectively.
- Assess clinical and radiographic outcomes of HBOT in limb salvage.
Main Methods:
- 18 patients with severe mangled extremities received standard treatment plus adjuvant HBOT.
- Follow-up averaged 22 months.
- Analyzed wound closure, surgery count, HBOT treatments, complications, and amputation rates.
Main Results:
- Most patients showed good to excellent clinical results post-HBOT.
- Limb salvage was successful in the majority of cases.
- Only one patient (5.56%) required amputation due to refractory osteomyelitis.
Conclusions:
- HBOT is a valuable adjunctive therapy for severe mangled extremities.
- Standard treatments (infection control, surgery) remain primary.
- Consider limb salvage with HBOT even for injuries with MESS ≥ 7.
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