Roje Z, Roje Z, Eterović D, Druzijanić N, Petrićević A, Roje T, Capkun V, et al.
Croatian medical journal. Date of publication 2008 Apr 1;volume 49(2):224-32.
1. Croat Med J. 2008 Apr;49(2):224-32.
Influence of adjuvant hyperbaric oxygen therapy on short-term complications
during surgical reconstruction of upper and lower extremity war injuries:
retrospective cohort study.
Roje Z(1), Roje Z, Eterović D, Druzijanić N, Petrićević A, Roje T, Capkun V.
Author information:
(1)Division of Plastic Surgery and Burns, Department of Surgery, Split University
Hospital Center, Soltanska 1, 21000 Split, Croatia. zdravko.roje@st.t-com.hr
AIM: To determine the effects of hyperbaric oxygen (HBO) therapy on short-term
complications of complex war wounds to the upper and lower extremities in
patients who were and those who were not treated according to North Atlantic
Treaty Organization (NATO) emergency war surgery recommendations.
METHOD: We retrospectively analyzed data of 388 male patients undergoing
reconstructive surgery for Gustilo type III A, B, and C war wounds to the
extremities at the Department of Reconstructive Surgery, Split University
Hospital Center, between 1991 and 1995. The occurrence of main wound
complications (deep infection, osteomyelitis, skin grafts lyses, and flap
necrosis) during hospitalization and time from wounding to granulation formation
were analyzed with respect to the use of HBO therapy as a risk factor. Odds ratio
(OR) with 95% confidence intervals (CI) was calculated for the occurrence of
wound complications with respect to HBO therapy and adjusted for NATO surgical
strategy by logistic regression.
RESULTS: Of 388 patients, 310 (80%) were initially treated according to the NATO
surgical strategy and 99 (25%) received HBO therapy. Deep soft-tissue infection
developed in 196 (68%) patients who did not receive HBO therapy and in 35 (35%)
who received it (P<0.001, xi(2) test). Osteomyelitis developed in 214 (74%)
patients who did not receive HBO therapy and in 62 (63%) who received it
(P=0.030). Skin graft lysis occurred in 151 (52%) patients who did not receive
HBO therapy and in 23 (23%) who received it (P<0.001). Flap necrosis occurred in
147 (51%) patients who did not receive HBO therapy and in 15 (15%) who received
it (P<0.001). Median time to granulation formation was 9 (5-57) days in patients
who received HBO therapy, and 12 (1-12) days in those who did not (P<0.001,
Mann-Whitney test). These results were consistent over the groups of patients
stratified according to the wound severity and remained unaltered after the
adjustment for NATO surgical strategy. The effect of HBO therapy was greater in
non-NATO than in NATO treated patients in case of deep soft-tissue infection (OR,
10.7 vs OR, 3.8; P=0.031 for interaction).
CONCLUSION: HBO therapy reduced the frequency of wound complications in patients
with Gustilo type III wounds and shortened the time to granulation formation. HBO
therapy was more effective in non-NATO than in NATO treated patients for the
prevention of deep soft-tissue infection but not flap necrosis.
PMCID: PMC2359875
PMID: 18461678 [Indexed for MEDLINE]