Hyperbaric oxygen therapy for severe blast injury of lower extremity after terrorist attack: case report

2019 ◽  
pp. 75-79
Author(s):  
Bengusu Mirasoglu ◽  
Engin Egeren ◽  
Huseyin Karakaya ◽  
Samil Aktas ◽  
Keyword(s):  
Lower Extremity ◽  
Hyperbaric Oxygen ◽  
Ischemia Reperfusion Injury ◽  
Wound Care ◽  
Terrorist Attack ◽  
Ischemia Reperfusion ◽  
Blast Injury ◽  
Tissue Level ◽  
Reconstructive Operations ◽  
Hbo2 Therapy

More blast injuries are encountered in the civilian setting in recent years as terrorist attacks have increased globally. A 17-year-old male patient with severe blast injury of the right lower extremity was admitted to our department on the fifth day after a terrorist bombing attack. Initially he had been admitted to an emergency department with segmental tibia fracture and arterial injury (Gustilo IIIC). An amputation had been foreseen due to ischemia that persisted even after orthopedic fixation and revascularization interventions, followed by fasciotomy incisions. After consultation with our department hyperbaric oxygen (HBO2) therapy was administered twice daily for the first week. Ischemia improved prominently after 10 HBO2 sessions. HBO2 therapy was continued together with antibiotherapy and wound care. The patient underwent a total of 40 HBO2 sessions and two reconstructive operations and healed without amputation. Vascular injuries with concomitant orthopedic trauma cause most of the delayed amputations in bombing attacks since ischemia can persist at the microvascular level even though adequate treatments are applied. HBO2 corrects hypoxia at tissue level and so provides oxygen for the critically ischemic cells in the injured area. HBO2 also enhances host defense and decreases the ischemia reperfusion injury. In this case, HBO2 was effective in survival and functional recovery (salvage) of the extremity together with regular wound care, antibiotherapy and surgical repair.

The effect of hyperbaric oxygen on compromised grafts and flaps

2020 ◽  
pp. 635-648
Author(s):  
Shawna Kleban Kleban ◽  
Richard C. Baynosa ◽  
Keyword(s):  
Reperfusion Injury ◽  
Hyperbaric Oxygen ◽  
Collagen Synthesis ◽  
Oxygen Therapy ◽  
Clinical Evidence ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Tissue Viability ◽  
Arterial Insufficiency ◽  
Hbo2 Therapy

The use of grafts and flaps serves as an integral tool in the armamentarium of the reconstructive surgeon. Proper planning and surgical judgment are critical in the ultimate success of these procedures. However, there are situations when grafts and/or flaps can become compromised and require urgent intervention for salvage. These instances can include irradiated or otherwise hypoxic wound beds, excessively large harvested grafts, random flap ischemia, venous or arterial insufficiency, and ischemia-reperfusion injury. Alternatively, compromised grafts and flaps can be inadvertently created secondary to trauma. It is in these types of cases, hyperbaric oxygen (HBO2) therapy can serve as a useful adjunct in the salvage of compromised flaps and grafts. This review outlines the extensive basic science and clinical evidence available in support of the use of HBO2 therapy for compromised grafts and flaps. The literature demonstrates the benefit of adjunctive HBO2 therapy for multiple types of grafts and flaps with various etiologies of compromise. HBO2 therapy can enhance graft and flap survival by several methods including decreasing the hypoxic insult, enhancing fibroblast function and collagen synthesis, stimulating angiogenesis and inhibiting ischemia-reperfusion injury. The expedient initiation of hyperbaric oxygen therapy as soon as flap or graft compromise is identified maximizes tissue viability and ultimately graft/flap salvage.

Lower extremity cooling reduces ischemia-reperfusion injury following Zone 3 REBOA in a porcine hemorrhage model

2018 ◽  
Vol 85 (3) ◽  
pp. 512-518 ◽  
Author(s):  
Meryl A. Simon ◽  
Emily M. Tibbits ◽  
Guillaume L. Hoareau ◽  
Anders J. Davidson ◽  
Erik S. DeSoucy ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Reperfusion Injury ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion

Hyperbaric oxygen worsens myocardial low flow ischemia-reperfusion injury in isolated rat heart

1997 ◽  
Vol 320 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Sonia Radice ◽  
Giuseppe Rossoni ◽  
Giorgio Oriani ◽  
Michael Michael ◽  
Enzo Chiesara ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Hyperbaric Oxygen ◽  
Rat Heart ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Isolated Rat Heart ◽  
Low Flow ◽  
Isolated Rat

scholarly journals An overview of protective strategies against ischemia/reperfusion injury: The role of hyperbaric oxygen preconditioning

2018 ◽  
Vol 8 (5) ◽  
pp. e00959 ◽  
Author(s):  
Ciprian Hentia ◽  
Alex Rizzato ◽  
Enrico Camporesi ◽  
Zhongjin Yang ◽  
Danina M. Muntean ◽  
...  
Keyword(s):  
Reperfusion Injury ◽  
Hyperbaric Oxygen ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Protective Strategies ◽  
Hyperbaric Oxygen Preconditioning

scholarly journals Hyperbaric Oxygen Improves Cerebral Ischemia/Reperfusion Injury in Rats Probably via Inhibition of Autophagy Triggered by the Downregulation of Hypoxia-Inducing Factor-1 Alpha

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Cuiting Wang ◽  
Feng Niu ◽  
Ningna Ren ◽  
Xiaokun Wang ◽  
Hequan Zhong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hyperbaric Oxygen ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Hypoxia Inducible Factor ◽  
Treatment Method ◽  
Male Rats ◽  
Sprague Dawley ◽  
Mortality And Morbidity ◽  
Bonferroni Test

Ischemic stroke, accompanied with high mortality and morbidity, may produce heavy economic burden to societies and families. Therefore, it is of great significance to explore effective therapies. Hyperbaric oxygen (HBO) is a noninvasive, nondrug treatment method that has been proved able to save ischemic penumbra by improving hypoxia, microcirculation, and metabolism and applied in various ischemic diseases. Herewith, we fully evaluated the effect of HBO on ischemic stroke and investigated its potential mechanism in the rat ischemia/reperfusion(I/R) model. Sixty Sprague-Dawley male rats were randomly divided into three groups—sham group, MCAO group, and MCAO+HBO group. In the latter two groups, the middle cerebral artery occlusion was performed (MCAO) for 2 hours, and then the occlusion was removed in order to establish the ischemic/reperfusion model. Subsequently, HBO was performed immediately after I/R (2 hours per day for 3 days). 72 hours after MCAO, the brain was dissected for our experiment. Finally, the data from three groups were analyzed by one-way analysis of variance (ANOVA) and followed by a Bonferroni test. In this article, we reported that HBO effectively reduced the infarction and edema and improved neurological functions to a certain extent. As shown by western blot analysis, HBO significantly reduced autophagy by regulating autophagy-related proteins (mTOR, p-mTOR, Atg13, LC3B II and LC3B II) in the hippocampus 72 hours after I/R, which was accompanied by inhibiting the expression of hypoxia inducible factor-1α (HIF-1α) in hippocampus. The results suggest that HBO may improve cerebral I/R injury, possibly via inhibiting HIF-1α, the upstream molecule of autophagy, and therefore, subsequently inhibiting autophagy in the rat model of ischemic stroke.

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