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Hyperbaric oxygen therapy for the treatment of a crush injury of the hand: a case report

  • Received : 2021.07.06
  • Accepted : 2021.09.01
  • Published : 2022.09.30

Abstract

We describe a case of hyperbaric oxygen therapy (HBOt) as an adjunct to treatment of a crush injury to the hand. A 34-year-old male paramedic was involved in a motor vehicle accident and admitted for diagnosis and surgical treatment. He sustained a crush injury to his right hand and presented with significant muscle damage, including multiple fractures and dislocations, an avulsion injury of the flexor tendons, and amputation of the distal phalanx of the little finger. He underwent reconstructive surgery and received HBOt over the following days. In the following 2 months, he lost the distal and middle phalanges of the little finger and recovered hand function. Posttraumatic compartment syndrome responds well to HBOt, which reduces edema and contributes to angiogenesis, as well as promoting the cascade of healing events. High-energy trauma causes massive cell destruction, and the blood supply is usually not sufficient to meet the oxygen demands of viable tissues. Hyperbaric oxygenation by diffusion through interstitial and cellular fluids increases tissue oxygenation to levels sufficient for the host's responses to injury to work and helps control the delayed inflammatory reaction. HBOt used as an adjunct to surgical treatment resulted in early healing and rehabilitation, accelerating functional recovery. The results suggest that adjunctive HBOt can be beneficial for the treatment of crush injuries of the hand, resulting in better functional outcomes and helping to avoid unnecessary amputations.

Keywords

Acknowledgement

The authors thank the healthcare teams from the emergency mobile care service of Cuiaba, Cuiaba Municipal Hospital, and Santa Rosa Hyperbaric Clinic, including physicians, nurses, physical therapists, and technicians who provided all the assistance required for the rescue and treatment of the patient.

References

  1. Goodman AD, Got CJ, Weiss AC. Crush injuries of the hand. J Hand Surg Am 2017;42:456-63. https://doi.org/10.1016/j.jhsa.2017.03.028
  2. Ahmad RS, Heng RW. Crush injuries of the hand part I: history, mechanism and pathomechanics. In: Salgado AA, editor. Essentials of hand surgery. London: IntechOpen; 2018. p. 83-104.
  3. Ahmad RS, Heng RW. Crush injuries of the hand part II: clinical assessment, management and outcomes. In: Salgado AA, editor. Essentials of hand surgery. London: IntechOpen; 2018. p. 105-36.
  4. Weaver LK. Hyperbaric oxygen therapy indications. 13rd ed. North Palm Beach: Best Publishing Company; 2014.
  5. Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P. Hyperbaric oxygen therapy in the management of crush injuries: a randomized double-blind placebo-controlled clinical trial. J Trauma 1996;41:333-9. https://doi.org/10.1097/00005373-199608000-00023
  6. Kerrigan CL, Stotland MA. Ischemia reperfusion injury: a review. Microsurgery 1993;14:165-75. https://doi.org/10.1002/micr.1920140307
  7. Strauss MB, Hart GB, Miller SS, et al. Mechanisms of hyperbaric oxygen. Part 1 primary: hyperoxygenation and pressurization. Wound Care Hyperb Med 2012;3:27-42.
  8. Strauss MB, Hart GB, Miller SS, et al. Mechanisms of hyperbaric oxygen. Part 2, secondary: tissue consequences of hyperoxygenation and pressurization. Wound Care Hyperb Med 2012;3:45-65.
  9. Bird AD, Telfer AB. Effect of hyperbaric oxygen on limb circulation. Lancet 1965;1:355-6. https://doi.org/10.1016/S0140-6736(65)91783-6
  10. Nylander G, Lewis D, Nordstrom H, Larsson J. Reduction of postischemic edema with hyperbaric oxygen. Plast Reconstr Surg 1985;76:596-603. https://doi.org/10.1097/00006534-198510000-00021
  11. Skyhar MJ, Hargens AR, Strauss MB, Gershuni DH, Hart GB, Akeson WH. Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in compartment syndromes associated with hemorrhagic hypotension. J Bone Joint Surg Am 1986;68:1218-24. https://doi.org/10.2106/00004623-198668080-00011
  12. Strauss MB, Hargens AR, Gershuni DH, Hart GB, Akeson WH. Delayed use of hyperbaric oxygen for treatment of a model anterior compartment syndrome. J Orthop Res 1986;4:108-11. https://doi.org/10.1002/jor.1100040114
  13. Sheffield PJ. Tissue oxygen measurements with respect to soft tissue wound healing with normobaric and hyperbaric oxygen. Hyperb Oxyg Rev 1985;6:18-46.
  14. Buras J. Basic mechanisms of hyperbaric oxygen in the treatment of ischemia-reperfusion injury. Int Anesthesiol Clin 2000;38:91-109. https://doi.org/10.1097/00004311-200001000-00007
  15. Zamboni WA, Roth AC, Russell RC, Nemiroff PM, Casas L, Smoot EC. The effect of acute hyperbaric oxygen therapy on axial pattern skin flap survival when administered during and after total ischemia. J Reconstr Microsurg 1989;5:343-7. https://doi.org/10.1055/s-2007-1006884