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Patient with Hx: Soft Tissue Radionecrosis (Basal Cell Carcinoma of Sternum), with partial sternectomy and omental flap, Radiation Tx 6/2/20 - 7/20/20 (total 33 txs). Started HBO Therapy 8/17/21. Order for 40 Txs, which were completed on 10/12/21. Order for additional 20 txs. Today 10/20/21 Tx # 46. Goal was to continue to 60 txs for Soft Tissue Radionecrosis, but during this time, Plastic Surgeon would debride wound and place a VRAM flap. 10/7/21 Tissue Exam (punch bx) sternal wound- neg for malignancy. 10/12/21 CT Angiogram Thoracic Aorta showed new and increased bil nodular densities, most likely infection or inflammation. 10/14/21 Cardiology/Pulmonology saw and scheduled for Bronchoscopy which was scheduled for 10/19/21. This was cancelled and rescheduled for 10/26/21 for Covid precautions. QUESTION: if we decide to hold HBO until after Bronchoscopy and determination of source of nodular densities, and scheduling and placement of VRAM flap, then restart. If we place pt on hold, HOW LONG can we wait before restarting HBO without compromising current benefits of treatment and being viewed as new episode of care? OR is it in the best interest of the patient to just complete the 60 treatments and if in the future there are complications with the flap healing, we could consider new episode of HBO therapy??
Oct 20, 2021 by Teresa, LPN/Hyperbaric Oxygen Tech
2 replies
Jeff Mize
RRT, CHT, UHMSADS
Teresa, thank you for reaching out to us. What was the total radiation dose? Radiation doses in excess of 40 Gray (4,000 cGy) are more commonly associated with compromised/delayed healing and persistent soft tissue/ integumentary breakdown within the previously irradiated field. These wounds often fail conservative wound management and/or surgical management. The role of hyperbaric oxygen is one of overcoming a hypovascular - hypocellular - hypoxic tissue bed and the late-radiation effects. Considering that the patient has received 46 treatments to date, what is the progress towards treatment goals? As well, has medical necessity been established to continue to a total of 60 txs? As for the time frame or how long you can wait before re-starting treatment, that would be determined by the viability of the VRAM flap.
Oct 20, 2021
Teresa
LPN/Hyperbaric Oxygen Tech
thanks for the phone conversation. very helpful
Oct 20, 2021
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